From the Department of Orthopedic Trauma Service, State University of New York Health Sciences Center, Stony Brook, NY.
J Am Acad Orthop Surg. 2018 Sep 15;26(18):640-651. doi: 10.5435/JAAOS-D-17-00160.
Fractures of the distal tibial plafond (ie, pilon) comprise a broad range of injury mechanisms, patient demographics, and soft-tissue and osseous lesions. Patients often present with considerably comminuted fracture patterns and notable soft-tissue compromise. Surgical intervention must be performed with respect for the exceedingly vulnerable soft-tissue envelope and with a properly executed technique. Even with proper timing, favorable host factors, and expert surgical technique, restoration of function and avoidance of complications are not always achievable. Recently validated techniques further diminish the risk of soft-tissue and osseous sepsis. These techniques include early (ie, "immediate") fixation, upgrading, primary arthrodesis, staged sequential posterior and anterior fixation, acute shortening, and transsyndesmotic fibular plating. Proper application of these recently adopted techniques may be instrumental in achieving aseptic union of pilon fractures.
距骨骨折（即 Pilon 骨折）涉及广泛的损伤机制、患者特征、软组织和骨损伤。患者常表现为严重粉碎性骨折模式和明显的软组织损伤。手术干预必须尊重极其脆弱的软组织包绕，并采用适当的技术。即使有适当的时机、有利的宿主因素和熟练的手术技术，也不一定能恢复功能和避免并发症。最近验证的技术进一步降低了软组织和骨感染的风险。这些技术包括早期（即“即刻”）固定、升级、一期融合、分期前后固定、急性短缩和经跗骨间腓骨钢板固定。这些最近采用的技术的正确应用可能对于 Pilon 骨折的无菌愈合至关重要。
