Daghino Walter, Messina Marco, Filipponi Marco, Alessandro Massè
CTO Hospital - I Clinic, Turin, Italy.
Lecce Hospital, Lecce, Italy.
Open Orthop J. 2016 Mar 30;10:49-55. doi: 10.2174/1874325001610010049. eCollection 2016.
The tibial pilon fractures represent a complex therapeutic problem for the orthopedic surgeon, given the frequent complications and outcomes disabling. The recent medical literature indicates that the best strategy to reduce amount of complications in tibial pilon fractures is two-stages procedure. We describe our experience in the primary stabilization of these fractures.
We treated 36 cases with temporary external fixation in a simple configuration, called "tripolar": this is an essential structure (only three screws and three rods), that is possible to perform even without the availability of X-rays and with simple anesthesia or sedation.
We found a sufficient mechanical stability for the nursing post-operative, in absence of intraoperative and postoperative problems. The time between trauma and temporary stabilization ranged between 3 and 144 hours; surgical average time was 8.4 minutes. Definitive treatment was carried out with a delay of a minimum of 4 and a maximum of 15 days from the temporary stabilization, always without problems, both in case of ORIF (open reduction, internal fixation) or circular external fixation.
Temporary stabilization with external fixator in 'tripolar' configuration seems to be the most effective strategy in two steps treatment of tibial pilon fractures. These preliminary encouraging results must be confirmed by further studies with more cases.
对于骨科医生而言，胫骨平台骨折是一个复杂的治疗难题，因为其并发症频繁且预后不佳。近期医学文献表明，减少胫骨平台骨折并发症数量的最佳策略是两阶段手术。我们描述了我们在这些骨折一期稳定治疗方面的经验。
我们采用一种简单构型的临时外固定治疗了36例患者，这种构型称为“三极”：这是一种基本结构（仅三枚螺钉和三根杆），即使没有X射线可用且仅采用简单麻醉或镇静也可实施。
我们发现术后护理时具有足够的机械稳定性，未出现术中及术后问题。创伤至临时固定的时间为3至144小时；手术平均时间为8.4分钟。从临时固定到最终治疗的延迟时间最短为4天，最长为15天，无论采用切开复位内固定（ORIF）还是环形外固定，均未出现问题。
“三极”构型的外固定器临时固定似乎是胫骨平台骨折两阶段治疗中最有效的策略。这些初步的令人鼓舞的结果必须通过更多病例的进一步研究来证实。
