Orthopaedic Department, Argos General Hospital, Argos, Greece.
J Orthop Trauma. 2013 Mar;27(3):153-7. doi: 10.1097/BOT.0b013e31825cf521.
To evaluate the treatment alternatives for the management of the metaphyseal tibial comminution in severe plafond fractures, and to investigate the role of the fibula fracture fixation.
Retrospective clinical study.
Level-2 trauma hospital.
Patients with highly comminuted tibial plafond fractures.
All patients were treated with open reduction and internal fixation of the articular surface and external fixation of the metaphyseal fracture. If metaphyseal comminution was minimal, bone graft was applied and the fibular was plated (group 1); if comminution was between 1 and 3 cm, acute shortening and distraction osteogenesis was performed (group 2); and if comminution was >3 cm, distraction osteogenesis without acute shortening was performed (group 3).
Radiographic union, AOFAS ankle score.
Of 30 fractures, 15 fractures (50%) had an anatomic reduction of the joint. Union occurred in all but 2 fractures. Group 1 fractures healed at an average of 19 weeks (16-22). Four fractures had associated malalignment problems. The mean AOFAS score was 72.5 (range 45-100). Group 2 fractures healed at an average of 18.3 weeks (16-21). One fracture healed with 5-degrees of angulation. Group 3 fractures healed at an average of 17.5 weeks (14-24). Two fractures healed with malalignment. When groups 2 and 3 were combined to evaluate the AOFAS outcome for fractures treated with distraction osteogenesis, a score of 75.83 was obtained (45-90). There was no difference between the Group 1 versus combined Groups 2/3 with regard to this latter score (P = 0.372). Additionally, when fibula fixation (Group 1) was compared with those fractures where it was not performed (groups 2/3), no difference was seen (P = 0.276).
The reconstruction of severe tibial plafond fractures treated with small wire hybrid fixation may be achieved by different techniques leading to a satisfactory result. The fixation of the fibula fracture is dependent mainly on the treatment chosen for the management of the metaphyseal lesion.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
评估治疗胫骨干骺端粉碎性骨折的方法，探讨腓骨骨折固定的作用。
回顾性临床研究。
二级创伤医院。
胫骨严重粉碎性平台骨折患者。
所有患者均采用关节面切开复位内固定和干骺端骨折外固定治疗。如果干骺端粉碎较小，行植骨和腓骨钢板固定（1 组）；如果粉碎在 1-3cm 之间，行急性短缩和牵张成骨（2 组）；如果粉碎＞3cm，行无急性短缩的牵张成骨（3 组）。
影像学愈合，AOFAS 踝评分。
30 例骨折中，15 例（50%）关节面解剖复位。除 2 例外，所有骨折均愈合。1 组骨折平均愈合时间为 19 周（16-22 周）。4 例出现对线不良问题。AOFAS 评分平均为 72.5 分（45-100 分）。2 组骨折平均愈合时间为 18.3 周（16-21 周）。1 例愈合时有 5°成角。3 组骨折平均愈合时间为 17.5 周（14-24 周）。2 例愈合时有对线不良。将 2 组和 3 组合并评估使用牵张成骨治疗的骨折 AOFAS 结果，得分为 75.83 分（45-90 分）。1 组与联合 2/3 组在该评分上无差异（P=0.372）。此外，当比较腓骨固定（1 组）与未固定（2/3 组）时，差异无统计学意义（P=0.276）。
胫骨平台严重粉碎性骨折采用小线混合固定重建，可采用不同技术达到满意效果。腓骨骨折的固定主要取决于干骺端病变的治疗选择。
治疗性 III 级。具体分级请查看作者指南。
