Department of Trauma And Orthopeadics, Addenbrookes Major Trauma Unit, Cambridge University Hospitals, United Kingdom; School of Clinical Medicine, University of Cambridge, CB2 0SP, United Kingdom.
Department of Trauma And Orthopeadics, Addenbrookes Major Trauma Unit, Cambridge University Hospitals, United Kingdom.
Injury. 2020 Nov;51(11):2717-2722. doi: 10.1016/j.injury.2020.08.029. Epub 2020 Aug 25.
The BOAST (British Orthopaedic Association Standards for Trauma) guidelines advise that open pilon fractures amongst other open lower limb fractures need to be treated at a specialist centre with Orthoplastic care. The purpose of this study was to determine clinical outcomes in patients with open pilon fractures treated as per BOAST guidelines alongside a treatment protocol which consisted of early wound debridement and spanning external fixation, delayed soft tissue coverage with a flap when necessary and delayed definitive fixation with the use of a Fine Wire Fixator.
We conducted a retrospective analysis of open pilon fractures treated between 2014 and 2019. All patients were included for the assessment of the rate of infection and fracture healing. Functional outcome assessment was performed in all patients according to the American Orthopaedic Foot and Ankle Score (AOFAS) at 12 months post injury.
There were 20 patients including 16 males and 4 females. The mean age was 50.45 years. Initial wound with bone debridement and application of a spanning external fixator was performed within an average of 13.5 hours. The mean time from primary surgery to definitive fixation was 24.5 days. There were 3 patients with Gustilo Type I injuries, 6 with Type II, 4 Type with type IIIa and 7 with Type IIIb injuries. Average time to bone union was 10.4 (Range: 2-18) months. The mean AOFAS score was 74.2 (Range: 28-97). A Taylor Spatial Frame was used on 18 patients, while 2 patients had an Ilizarov frame. A corticotomy was performed on 4 patients with critical bone defect post debridement. There was 1 case of deep infection and 9 cases of superficial infection. There were also 4 cases of delayed union which required bone grafting from their femur using a RIA (Reamer Irrigation Aspirator).
Our study suggests that the use of staged wound debridement including relatively aggressive bone debridement in conjunction with systemic and local antibiotics, external fixators and patient tailored conversion from spanning external fixator to fine wire frame achieves low rates of wound infection and complications for patients with open pilon fractures.
英国矫形协会创伤标准（BOAST）指南建议，开放性PILON 骨折和其他开放性下肢骨折需要在矫形整形外科中心接受治疗。本研究的目的是确定按照 BOAST 指南治疗的开放性 PILON 骨折患者的临床结果，同时采用治疗方案，包括早期清创和跨距外固定架固定，必要时使用皮瓣延迟软组织覆盖，以及使用细钢丝固定器进行延迟确定性固定。
我们对 2014 年至 2019 年期间治疗的开放性 PILON 骨折进行了回顾性分析。所有患者均接受感染和骨折愈合率的评估。所有患者均根据美国矫形足踝协会评分（AOFAS）在受伤后 12 个月进行功能评估。
共有 20 例患者，其中男性 16 例，女性 4 例。平均年龄为 50.45 岁。初始清创和跨距外固定架应用平均在 13.5 小时内完成。从初次手术后到确定性固定的平均时间为 24.5 天。有 3 例 Gustilo Ⅰ型损伤，6 例Ⅱ型，4 例Ⅲa 型和 7 例Ⅲb 型损伤。骨愈合的平均时间为 10.4（范围：2-18）个月。平均 AOFAS 评分为 74.2（范围：28-97）。18 例患者使用泰勒空间框架，2 例患者使用伊里扎洛夫框架。4 例清创后有严重骨缺损的患者进行了骨切开术。有 1 例深部感染，9 例浅部感染。还有 4 例延迟愈合，需要从股骨取 RIA（扩髓冲洗吸引器）进行植骨。
我们的研究表明，采用分期清创术，包括相对激进的骨清创术，结合全身和局部抗生素、外固定架以及根据患者情况从跨距外固定架转换为细钢丝框架，可降低开放性 PILON 骨折患者的伤口感染和并发症发生率。
