Department of Orthopedic and Trauma Surgery, University Hospital Cologne, Kerpener Street 62, 50937, Cologne, Germany.
Arch Orthop Trauma Surg. 2021 May;141(5):837-844. doi: 10.1007/s00402-020-03538-9. Epub 2020 Jul 27.
Operative management of pilon fractures, especially high-energy compression injuries, is a challenge. Operative education is of vital importance to handle these entities. Not rarely, it is cut by economics and staff shortage. As public awareness toward operative competence rises, surgical cadaver courses that provide pre-fractured specimens can improve realism of teaching scenarios. The aim of this study is to introduce a realistic pilon fracture simulation setup regarding the injury mechanism.
8 cadaveric specimens (two left, six right) were fixed onto a custom drop-test bench in dorsiflexion (20°) and light supination (10°). The proximal part of the lower leg was potted, and the specimen was exposed to a high energetic impulse via an axial impactor. CT imaging was performed after fracture simulation to detect the exact fracture patterns and to classify the achieved fractures by two independent trauma surgeons. (AO/OTA recommendations and the Rüedi/Allgöwer).
All cadaveric specimens could be successfully fractured: 6 (75%) were identified as a 43-C fracture and 2 (25%) as 43-B fracture type. Regardless of the identical mechanism two different kinds of fracture types were reported. In five cases (62.5%), the fibula was also fractured and in three specimens, a talus fracture was described. There was no statistically significant correlation found regarding Hounsfield Units (HU) and age as well as HU and required kinetic energy.
A high energetic axial impulse on a fixed ankle specimen in light dorsiflexion (20°) and supination (10°) induced by a custom-made drop-test bench can successfully simulate realistic pilon fractures in cadaveric specimens with intact soft tissue envelope. Although six out of eight fractures (75%) were classified as a 43-C fracture and despite putting a lot of effort into the mechanical setup, we could not achieve an absolute level of precision. Therefore, we suggest that the injury mechanism is most likely a combination of axial loading, shear and rotation.
III.
对于 Pilon 骨折，尤其是高能压缩损伤的手术治疗是一个挑战。手术教育对于处理这些损伤至关重要。但由于经济和人员短缺，手术教育往往被削减。随着公众对手术能力的认识提高，提供预骨折标本的外科尸体课程可以提高教学场景的现实性。本研究的目的是介绍一种基于损伤机制的真实 Pilon 骨折模拟设置。
8 个尸体标本（左 2 个，右 6 个）固定在定制的跌落试验台上，呈背屈（20°）和轻度旋前（10°）位。小腿近端被盆栽固定，标本通过轴向冲击器受到高能脉冲的冲击。骨折模拟后进行 CT 成像，以检测确切的骨折模式，并由两名独立的创伤外科医生对获得的骨折进行分类（AO/OTA 推荐和 Rüedi/Allgöwer）。
所有尸体标本均成功骨折：6 个（75%）被鉴定为 43-C 型骨折，2 个（25%）为 43-B 型骨折。尽管采用相同的机制，但报告了两种不同类型的骨折。在 5 例（62.5%）中，腓骨也骨折，在 3 个标本中，描述了距骨骨折。Hounsfield 单位（HU）与年龄以及 HU 与所需动能之间没有发现统计学上的显著相关性。
通过定制的跌落试验台，对固定在轻度背屈（20°）和旋前（10°）位的踝关节标本施加高能轴向脉冲，可以成功地在完整软组织包膜的尸体标本中模拟真实的 Pilon 骨折。尽管 8 个骨折中有 6 个（75%）被分类为 43-C 型骨折，尽管我们在机械设置上付出了很多努力，但我们无法达到绝对的精确水平。因此，我们认为损伤机制很可能是轴向载荷、剪切和旋转的组合。
III 级。
