Klaue K
Reparto di Chirurgia Ortopedica, Clinica Luganese, 6900, Lugano, Schweiz.
Unfallchirurg. 2017 Aug;120(8):648-651. doi: 10.1007/s00113-017-0377-3.
Under optimal conditions, fractures of the tibial pilon can be definitively managed operatively within 6 h after the trauma. Under suboptimal conditions, preoperative antiphlogistic treatment, possibly after approximate correction and external fixation of the alignment, is a reasonable option. Osteosynthesis implies reconstruction of good joint congruency in anatomical orientation. The soft tissue coverage of the distal lower leg is relatively poorly constructed and there is a high risk of devascularization, necrosis and ensuing infection.
Several local accesses with complete visual control of the joint surface enable a strain-free soft tissue handling and thus reduction of the incidence of complications. Besides a specific access to the fibula fracture, two anterior and two posterior accesses are proposed based on normal vascularization. These accesses can be simultaneously combined. Using a bone distractor facilitates control of the joint surface.
Open reduction and stabilization of pilon fractures enables rapid restoration of joint mobility. After having analyzed the fracture and setting the priorities, the treatment strategy should include a well-thought out selection of possible accesses.
在最佳条件下，胫骨平台骨折可在创伤后6小时内进行确定性手术治疗。在非最佳条件下，术前抗炎治疗，可能在大致矫正和对线外固定后进行，是一种合理的选择。骨合成意味着在解剖学方向上重建良好的关节一致性。小腿远端的软组织覆盖相对较差，存在血管化丧失、坏死及随之而来的感染的高风险。
几种能完全直视关节面的局部入路可实现无张力的软组织处理，从而降低并发症的发生率。除了特定的腓骨骨折入路外，基于正常的血管分布，还提出了两个前入路和两个后入路。这些入路可同时联合使用。使用骨撑开器有助于控制关节面。
胫骨平台骨折的切开复位内固定可使关节活动度迅速恢复。在分析骨折并确定优先事项后，治疗策略应包括精心选择可能的入路。
