Department of Surgery, University Hospital Ayr, Ayr, United Kingdom.
Division of foot, ankle and limb reconstruction surgery, Department of Trauma and Orthopaedics, The Queen Elizabeth University Hospital, Glasgow, United Kingdom.
Foot (Edinb). 2021 Jun;47:101780. doi: 10.1016/j.foot.2021.101780. Epub 2021 Jan 21.
Pilon fractures are severe, intra-articular and comminuted fractures to the distal tibia. They are uncommon injuries and are often associated with fibular fractures. The optimal management of these fractures is widely debated. Open reduction and internal fixation (ORIF) and external fixation have been used to treat these fractures. Ankle arthrodesis is often used in the latter stages of management for end-stage ankle arthritis. The aim of this systematic review was to identify the outcomes associated with using primary ankle arthrodesis in pilon fractures.
Ovid Medline and PubMed were searched from the inception of their databases until October 2018. Eligible literature for use in our review included patient cohorts that had been operated in the form of primary ankle arthrodesis. All relevant data was included that met the inclusion criteria. The demographic of the patients with pilon fractures and this operative management were identified. The outcomes of interest were fusion rate, infection rate, length of follow-up and patient reported outcomes. 8 papers were deemed eligible for review.
Of the 8 papers that were eligible, 6 were retrospective studies, 1 was a case report and 1 was an abstract. There were a total of 109 patients included. Fusion rate was 100% in 5 of the studies. 6 of the 7 studies that reported on infection rate had no post-operative infections. Outcome assessment scores were used in 5 of the studies. The SF-36 score, the FOAS and the AOFAS were used.
This review shows that primary ankle arthrodesis yields reasonable results in the management of pilon fractures. However, the quantity and quality of current literature is not sufficient and further studies with larger cohorts and longer follow-up times are warranted.
Pilon 骨折是一种严重的、关节内和粉碎性的胫骨远端骨折。它们是不常见的损伤，通常与腓骨骨折有关。这些骨折的最佳治疗方法存在广泛争议。切开复位内固定（ORIF）和外固定已被用于治疗这些骨折。踝关节融合术常用于管理的后期阶段，用于治疗终末期踝关节关节炎。本系统评价的目的是确定在 Pilon 骨折中使用初次踝关节融合术相关的结果。
从 Ovid Medline 和 PubMed 数据库的创建开始搜索，直到 2018 年 10 月。用于本综述的合格文献包括已接受初次踝关节融合术治疗的患者队列。所有符合纳入标准的相关数据都包括在内。确定 Pilon 骨折患者和这种手术治疗的人口统计学特征。感兴趣的结果是融合率、感染率、随访时间和患者报告的结果。有 8 篇论文被认为符合审查条件。
在符合条件的 8 篇论文中，有 6 篇是回顾性研究，1 篇是病例报告，1 篇是摘要。共有 109 例患者纳入研究。5 项研究中的融合率为 100%。6 项报告感染率的研究中没有术后感染。5 项研究使用了结局评估评分。使用了 SF-36 评分、FOAS 和 AOFAS。
本综述表明，初次踝关节融合术在 Pilon 骨折的治疗中取得了合理的结果。然而，目前文献的数量和质量不足，需要进一步进行队列更大、随访时间更长的研究。
