Liangjun Jiang, Qiang Zheng, Hang Li, Zhijun Pan
The Orthopedics Department of 2nd Affiliated Hospital of Medical College of Zhejiang University, The Jiefang Road 88#, Hangzhou, Zhejiang, China.
J Clin Orthop Trauma. 2017 Nov;8(Suppl 2):S9-S15. doi: 10.1016/j.jcot.2017.05.002. Epub 2017 May 12.
The effect of intact fibula on pilon fracture is not completely elucidated. We retrospectively analysed pilon fractures with intact fibula at our hospital over a 4 year period to understand the injury mechanism, fracture characteristics, treatment strategy and prognosis of this fracture.
Pilon fracture patients with intact fibula treated in our hospital from January 2010 to December 2014 were observed. OA/ATO fracture type, Ruedi-Allgower classification and fracture characteristics were summarised. The following data were collected from the charts: operative time, operative approach, fixation, fracture healing time, ankle joint Mazur scores, Burwell-Charnley fracture reduction scores and postoperative complications.
Twenty-two patients were followed up with a mean follow-up time of 17.6 months (10-27 months). The examination results showed the existence of distal tibiofibular syndesmosis injuries, medial malleolus, posterior malleolar, and anterior tibial fractures, and talus-fibula relationship changes, which accounted for 65.2%, 69.3%, 73.9%, 100% and 26.1%, respectively. 19 cases underwent internal fixation, with an average operation time of 108 min. The mean fracture healing time was 6.74 months. The Mazur ankle score showed excellent and good ratings of 86.9%. The Burwell-Charnley fracture reduction score had good and fair ratings of 95.7%. Skin infection occurred in two cases.
Pilon fracture with intact fibula is mostly caused by medium-low energy injury when the ankle is at neutral or varus position. Multi-part fractures commonly occur at the distal tibial articular surface because the energy is concentrated on the tibia. In general, one single anterior approach can complete open reduction and internal fixation operation with satisfactory clinical outcomes in most cases.
完整腓骨对pilon骨折的影响尚未完全阐明。我们回顾性分析了我院4年间收治的伴有完整腓骨的pilon骨折患者，以了解该骨折的损伤机制、骨折特点、治疗策略及预后。
观察2010年1月至2014年12月在我院治疗的伴有完整腓骨的pilon骨折患者。总结OA/ATO骨折类型、Ruedi-Allgower分型及骨折特点。从病历中收集以下数据：手术时间、手术入路、固定方式、骨折愈合时间、踝关节Mazur评分、Burwell-Charnley骨折复位评分及术后并发症。
22例患者获得随访，平均随访时间17.6个月（10 - 27个月）。检查结果显示，胫腓下联合损伤、内踝、后踝及胫骨前缘骨折以及距骨 - 腓骨关系改变的发生率分别为65.2%、69.3%、73.9%、100%和26.1%。19例行内固定手术，平均手术时间108分钟。平均骨折愈合时间为6.74个月。Mazur踝关节评分优良率为86.9%。Burwell-Charnley骨折复位评分优良率为95.7%。2例发生皮肤感染。
伴有完整腓骨的pilon骨折多由踝关节处于中立位或内翻位时的中低能量损伤所致。由于能量集中在胫骨，多部位骨折常见于胫骨远端关节面。一般来说，多数情况下单一前入路即可完成切开复位内固定手术，临床效果满意。
