Aneja Arun, Luo T David, Liu Boshen, Domingo Molina, Danelson Kerry, Halvorson Jason J, Carroll Eben A
Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY 40536, USA.
Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA.
Injury. 2018 Feb;49(2):409-413. doi: 10.1016/j.injury.2017.12.015. Epub 2017 Dec 16.
Intra-articular Pilon fractures remain therapeutically challenging due to osteochondral fracturing and comminution, marginal impaction, and insult to the soft tissue envelope. The purpose of this study was to compare the efficacy of anterolateral distal tibial locking plates in capturing main fracture fragments in tibial plafond fractures.
From May 2011 to Dec 2015, 169 OTA C-type pilon fractures met inclusion and exclusion criteria with computed tomographic (CT) scans performed prior to definitive fixation. For each patient, the fracture lines were mapped, digitized, and graphically superimposed to create a compilation of fracture lines. Based on these average measurements, three distal tibia sawbones had three different anterolateral plates applied. Axial CT scan images were used to determine the efficacy of screw purchase in main fracture fragments in pilon fractures.
The Smith & Nephew PERI-LOC plate secured the largest number of fracture lines (90.1%) but missed the Volkmann fragment with greatest frequency at 3.6%. The Synthes 2.7/3.5 mm VA-LCP captured 87.3% of the fracture lines while missing the Volkmann fragment 3.2% of the time. The Synthes 3.5 mm LCP captured 86.5% of the fracture lines but was the best at securing the Volkmann fragment (1.2% missed). All three implants were deficient in capturing the medial malleolar fragment. The PERI-LOC and 2.7/3.5 mm VA-LCP did not differ with respect to percentage of fragments captured (p = 0.721) but both outperformed the 3.5 mm LCP (p = 0.021 and p = 0.05, respectively).
This study was consistent with prior literature in defining three main fracture fragments: anterior, medial, and posterior. All three plates were deficient in capturing the medial malleolar fragment. The Smith and Nephew PERI-LOC plate secured the most number of fracture lines, while the Synthes 3.5 mm LCP was least likely to miss the Volkmann fragment and most likely to miss the medial malleolar fragment. No plate was found to be superior to the other in capturing all fracture lines of the OTAC3 pilon fragments.
Three.
由于存在骨软骨骨折和粉碎、边缘撞击以及软组织包膜损伤，关节内Pilon骨折的治疗仍具有挑战性。本研究的目的是比较胫骨干骺端前外侧锁定钢板在固定胫骨平台骨折主要骨折块方面的疗效。
2011年5月至2015年12月，169例OTA C型Pilon骨折符合纳入和排除标准，并在最终固定前进行了计算机断层扫描（CT）。对每位患者的骨折线进行标记、数字化处理并进行图形叠加，以创建骨折线汇编。基于这些平均测量结果，对三个胫骨干骺端锯骨模型应用三种不同的前外侧钢板。轴向CT扫描图像用于确定钢板螺钉固定胫骨平台骨折主要骨折块的疗效。
史赛克PERI-LOC钢板固定的骨折线数量最多（90.1%），但 Volkman 骨折块漏固定的频率最高，为3.6%。Synthes 2.7/3.5mm VA-LCP固定了87.3%的骨折线，漏固定Volkmann骨折块的时间为3.2%。Synthes 3.5mm LCP固定了86.5%的骨折线，但在固定Volkmann骨折块方面效果最佳（漏固定率为1.2%）。所有三种植入物在固定内踝骨折块方面均存在不足。PERI-LOC钢板和2.7/3.5mm VA-LCP在固定骨折块的百分比方面无差异（p = 0.721），但均优于3.5mm LCP（p分别为0.021和0.05）。
本研究与先前文献一致，确定了三个主要骨折块：前侧、内侧和后侧。所有三种钢板在固定内踝骨折块方面均存在不足。史赛克PERI-LOC钢板固定的骨折线数量最多，而Synthes 3.5mm LCP漏固定Volkmann骨折块的可能性最小，漏固定内踝骨折块的可能性最大。在固定OTA C3型Pilon骨折块的所有骨折线方面，未发现哪种钢板优于其他钢板。
三级。
