Minator Sajjadi Mohammadreza, Ebrahimpour Adel, Okhovatpour Mohammad A, Karimi Amin, Zandi Reza, Sharifzadeh Amir
Research performed at Taleghani hospital, shahid beheshti medical university, Tehran, Iran.
Taleghani Hospital, Research Development Unit, Department of Orthopedic Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Arch Bone Jt Surg. 2018 Sep;6(5):412-419.
Pilon fracture is one of the challenging injuries in orthopedic surgery. Associated soft tissue injury is an important factor in choosing treatment options. Two major methods of treatment are considered as one-stage open reduction internal fixation (ORIF) and two-stage treatment (primary external fixation and secondary ORIF). The latter is most accepted in literature. In the current study, we compared the results of these two methods.
In a retrospective study, 41 patients were assigned to two groups containing one-stage primary ORIF (21 patients) group, and two-stage group included external fixation and secondary ORIF (20 patients). The rate of infection (superficial or deep infection, osteomyelitis), malunion, nonunion, duration of hospital stay, neurovascular injury, pain intensity, and patients' satisfaction with AOFAS score, were compared between the two groups.
There was no significant difference between the two groups in measured variables except hospital stay which was significantly longer for the two-stage group.
Based on our findings, we recommend using one stage ORIF for a patient with Pilon fractures type C and Tscherne 1, 2 if the patient is planned to be operated on during the first 24 hours after the injury.
Pilon骨折是骨科手术中具有挑战性的损伤之一。相关软组织损伤是选择治疗方案的重要因素。两种主要治疗方法被认为是一期切开复位内固定（ORIF）和两阶段治疗（一期外固定和二期ORIF）。后者在文献中最被认可。在本研究中，我们比较了这两种方法的结果。
在一项回顾性研究中，41例患者被分为两组，一组为一期初次ORIF（21例患者）组，另一组为两阶段组，包括外固定和二期ORIF（20例患者）。比较两组之间的感染率（浅表或深部感染、骨髓炎）、骨不连、骨不愈合、住院时间、神经血管损伤、疼痛强度以及患者对AOFAS评分的满意度。
除住院时间外，两组测量变量之间无显著差异，两阶段组的住院时间明显更长。
基于我们的研究结果，我们建议对于C型和Tscherne 1、2型Pilon骨折患者，如果计划在受伤后24小时内进行手术，采用一期ORIF。
