Department of Orthopaedic Surgery, National University Hospital, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore.
OrthoSports-Clinic for Orthopedic Surgery and Sports Medicine, Mt Elizabeth Novena Specialist Centre, Singapore, Singapore.
Arch Orthop Trauma Surg. 2022 Nov;142(11):2999-3007. doi: 10.1007/s00402-021-03901-4. Epub 2021 Apr 16.
Operative treatment of tibial pilon fracture is challenging. There is a lack of consensus and only one clinical study on the optimal location of distal tibial plating for fixation of pilon fractures based on varus or valgus fracture patterns. We hypothesize that complications rates, specifically mechanical complications, are not influenced by the location of the tibial plating in the fixation of pilon fractures with respect to varus or valgus fracture patterns.
Sixty-nine patients who had single plating for tibial pilon from 2007 to 2017 were recruited. They were divided into two groups, transverse fibular fracture (varus fracture pattern) and comminuted fibular fracture (valgus fracture pattern). Our primary outcome measure was any mechanical complications as a result of the location of plating (medial vs lateral) on varus or valgus fracture patterns.
There were 38 (55.1%) patients with varus fracture pattern and 31 (44.9%) patients with valgus fracture pattern tibial pilon fractures. In the varus fracture pattern group, mechanical complications were not significantly different between the two plating locations (27.3 vs 33.3%, p > 0.05). Notably, there were more fibula fixations performed in patients with medial plating (74.1 vs 45.5%, p = 0.092) when compared those with lateral plating in the varus fracture pattern group. There were also no statistically significant differences found although 10 (40%) out of 25 patients had mechanical complications in the medial plating group compared to 1 (16.7%) out of 6 patients with lateral plating (p = 0.383) in the valgus fracture pattern group.
There were no differences in mechanical complications for medial vs lateral plating in tibial pilon fracture based on varus or valgus deforming forces. As much as we should consider the fracture patterns and deforming forces when deciding on plating location, other factors such as careful soft tissue management and fragment-specific fixation should be prioritized.
胫骨 Pilon 骨折的手术治疗具有挑战性。目前，基于内翻或外翻骨折模式，对于固定 Pilon 骨折时胫骨远端接骨板的最佳位置，还没有共识，仅有一项临床研究。我们假设，在考虑接骨板位置时，并发症发生率，特别是机械并发症，不会因 Pilon 骨折的内翻或外翻骨折模式而受到影响。
2007 年至 2017 年间，共招募了 69 例接受单钢板治疗的胫骨 Pilon 骨折患者。他们被分为两组，即横形腓骨骨折（内翻骨折模式）和粉碎性腓骨骨折（外翻骨折模式）。我们的主要观察指标是接骨板位置（内侧 vs 外侧）对内翻或外翻骨折模式下的机械并发症的影响。
38 例（55.1%）患者为内翻骨折模式，31 例（44.9%）患者为外翻骨折模式的胫骨 Pilon 骨折。在内翻骨折模式组中，两种接骨板位置的机械并发症无显著差异（27.3%比 33.3%，p>0.05）。值得注意的是，在内翻骨折模式组中，内侧接骨板的腓骨固定率（74.1%比 45.5%，p=0.092）明显高于外侧接骨板。在外翻骨折模式组中，尽管内侧接骨板组有 10 例（40%）发生了机械并发症，而外侧接骨板组只有 1 例（16.7%）（p=0.383），但两组之间也没有统计学上的显著差异。
在内翻或外翻成角力作用下，胫骨 Pilon 骨折中内侧接骨板与外侧接骨板的机械并发症无差异。在决定接骨板位置时，我们应该考虑骨折模式和成角力，但也应优先考虑其他因素，如仔细的软组织管理和骨折块特异性固定。
