Danoff Jonathan R, Saifi Comron, Goodspeed David C, Reid J Spence
Department of Orthopaedic Surgery, Columbia University Medical Center, 622 West 168th St., PH1130, New York, NY, 10032, USA,
Eur J Orthop Surg Traumatol. 2015 Apr;25(3):569-75. doi: 10.1007/s00590-014-1552-7. Epub 2014 Sep 26.
Open pilon fracture management and treatment poses a significant challenge to orthopedic surgeons. The purpose of this study was to determine patient outcomes for open pilon fractures based on wound complication and infection rates, as well as subjective outcome instruments.
This was a retrospective consecutive case series of 28 fractures with Orthopaedic Trauma Association (OTA)-type 43-B and 43-C open pilon fractures. Mean length of follow-up was 36 months and minimum of 1 year. Ten fractures were Gustilo and Anderson grade IIIB, and the remaining fractures were grades I-IIIA. Patients were initially treated with spanning external fixation and staged wound debridement followed by osteosynthesis of the articular surface. Metaphyseal fixation was by either plate fixation or Ilizarov frame. The primary outcome was the incidence of deep tissue infection requiring surgery. Secondary outcomes included the incidence of other complications (nonunion, malunion, amputation) and functional outcomes (Short Musculoskeletal Functional Assessment Questionnaire and AAOS Foot and Ankle Questionnaire).
Four patients developed deep tissue infections, three in the internal fixation group and one in the Ilizarov group, and all were treated successfully with staged debridement. There were two delayed unions required bone grafting, and infection-free union was ultimately achieved in all fractures. Two patients underwent arthrodesis secondary to post-traumatic arthritis, while no patients experienced malunions or amputations.
The use of staged wound debridement in conjunction with either plate fixation or Ilizarov frame achieves low rates of wound infection and stable fixation after anatomic joint reconstruction for OTA-type 43-B and 43-C open pilon fractures.
开放性pilon骨折的处理和治疗对骨科医生构成了重大挑战。本研究的目的是根据伤口并发症和感染率以及主观结果指标来确定开放性pilon骨折患者的治疗结果。
这是一项回顾性连续病例系列研究，纳入了28例符合骨科创伤协会（OTA）43 - B型和43 - C型的开放性pilon骨折。平均随访时间为36个月，最短为1年。10例骨折为Gustilo和Anderson IIIB级，其余骨折为I - IIIA级。患者最初接受跨关节外固定和分期伤口清创，随后进行关节面的接骨术。干骺端固定采用钢板固定或伊里扎洛夫架固定。主要结局是需要手术治疗的深部组织感染发生率。次要结局包括其他并发症（骨不连、畸形愈合、截肢）的发生率以及功能结局（短肌肉骨骼功能评估问卷和美国骨科医师学会足踝问卷）。
4例患者发生深部组织感染，内固定组3例，伊里扎洛夫组1例，所有患者均通过分期清创成功治疗。有2例延迟愈合需要植骨，所有骨折最终均实现了无感染愈合。2例患者因创伤后关节炎接受了关节融合术，而没有患者出现畸形愈合或截肢。
对于OTA 43 - B型和43 - C型开放性pilon骨折，采用分期伤口清创联合钢板固定或伊里扎洛夫架固定，在解剖关节重建后可实现低伤口感染率和稳定固定。
