Hebert-Davies Jonah, Kleweno Conor P, Nork Sean E
Department of Orthopaedics and Sports Medicine, Harborview Medical Center, University of Washington, Seattle, WA.
J Orthop Trauma. 2020 Feb;34 Suppl 1:S14-S20. doi: 10.1097/BOT.0000000000001698.
The treatment of tibial pilon fractures has evolved substantially over the past decades due to ever-increasing high-energy injuries. Open reduction and internal fixation of these intra-articular fractures requires an appreciation for a number of basic principles: respect the soft tissues, understand the fracture pattern, use safe surgical approaches, and provide stability that allows for early motion of the ankle. Surgical strategy should be customized based on the fracture pattern, access needed for fracture visualization and reduction, and status of the soft tissues. Given the ability to obtain an accurate stable reduction, smaller implants are typically adequate using multiple small incisions. We view this surgical tactic as continuing the evolution of complex fracture treatment whose origins lie in the influences of pioneers such as Dr Sigvard T. Hansen Jr.
在过去几十年中，由于高能量损伤不断增加，胫骨平台骨折的治疗方法有了很大的发展。这些关节内骨折的切开复位内固定需要遵循一些基本原则：尊重软组织，了解骨折类型，采用安全的手术入路，并提供能使踝关节早期活动的稳定性。手术策略应根据骨折类型、骨折显露和复位所需的入路以及软组织状况进行定制。鉴于能够获得准确稳定的复位，使用多个小切口时通常较小的植入物就足够了。我们认为这种手术策略是复杂骨折治疗方法演变的延续，其起源可追溯到西格瓦德·T·汉森博士等先驱者的影响。
