Sukur E, Akman Y E, Gokcen H B, Ozyurek E C, Senel A, Ozturkmen Y
Sakarya Education and Research Hospital, Department of Orthopedics and Traumatology, 54100 Sakarya, Turkey.
M.S. Baltalimani Bone Diseases Training and Research Hospital, Department of Orthopedics and Traumatology, 34470 Istanbul, Turkey.
Orthop Traumatol Surg Res. 2017 Sep;103(5):703-707. doi: 10.1016/j.otsr.2017.05.012. Epub 2017 Jun 9.
Pilon variant posterior malleolar (PVPM) fractures significantly disrupt joint congruency and cause tibiotalar instability. They are often underestimated and inadequately treated.
This study assessed the outcomes of surgical treatment of this subtype of malleolar fracture, and examined the importance of computed tomography (CT) in diagnosis and surgical treatment.
CT images and radiographs of 67 patients with trimalleolar ankle fractures were retrospectively analyzed. Fourteen patients (6 women and 8 men) were studied. The mean age was 37.7 (range, 21-58) years, and mean follow-up period was 17.1 (range, 12-24) months. All patients underwent open reduction. Reconstruction of the joint surface was assessed with postoperative CT images. The outcomes were assessed with the American Academy of Orthopaedic Surgeons (AAOS) and Osteoarthritis (OA) scoring systems.
The ratio of PVPM fractures to trimalleolar ankle fractures was 20.1%. Postoperative CT images demonstrated that anatomic reconstruction was achieved in 11 patients. The mean AAOS scores were 85.6 in Type 1 and 81.1 in Type 2 cases. The mean OA scores were 1 in Type 1 and 1.1 in Type 2 cases (P>0.05). The only statistically significant difference between the 2 groups was in osteochondral impaction (P<0.05).
CT imaging is essential for the accurate diagnosis and management of PVPM fractures. Posteromedial and posterolateral incisions enable direct exposure, and therefore facilitate joint surface reconstruction.
Level IV. Retrospective study.
Pilon变异型后踝（PVPM）骨折会显著破坏关节的一致性并导致胫距关节不稳定。它们常常被低估且治疗不充分。
本研究评估了这种亚型踝关节骨折的手术治疗效果，并探讨了计算机断层扫描（CT）在诊断和手术治疗中的重要性。
回顾性分析67例三踝骨折患者的CT图像和X线片。对14例患者（6例女性和8例男性）进行研究。平均年龄为37.7岁（范围21 - 58岁），平均随访时间为17.1个月（范围12 - 24个月）。所有患者均接受切开复位。术后通过CT图像评估关节面的重建情况。采用美国矫形外科医师学会（AAOS）和骨关节炎（OA）评分系统评估治疗效果。
PVPM骨折占三踝骨折的比例为20.1%。术后CT图像显示11例患者实现了解剖重建。1型病例的平均AAOS评分为85.6分，2型病例为81.1分。1型病例的平均OA评分为1分，2型病例为1.1分（P>0.05）。两组之间唯一具有统计学意义的差异在于骨软骨撞击方面（P<0.05）。
CT成像对于PVPM骨折的准确诊断和治疗至关重要。后内侧和后外侧切口可实现直接暴露，从而便于关节面重建。
IV级。回顾性研究。
