Consultant of Orthopedic Surgery, Helwan University, Helwan, Egypt.
Consultant of Orthopedic Surgery, AL-Razi Orthopedic Hospital, Kuwait.
J Foot Ankle Surg. 2022 May-Jun;61(3):590-603. doi: 10.1053/j.jfas.2021.10.018. Epub 2021 Oct 23.
Tibial plafond fractures are often associated with significant articular cartilage and soft tissue damage. The presence of co-morbidities has been associated with an increased risk of surgical site complications. With improved in surgical techniques and implants, complication rates have declined; however, the overall prognosis often remains poor. The aims of this study were to evaluate the results of innovative minimally invasive reduction and fixation techniques in tibial plafond fractures based on a CT classification and to compare the difference between short and long-term outcomes. Based on preoperative CT findings, fractures were classified into varus, valgus, anterior, posterior, and neutral types. The minimally invasive reduction and fixation techniques depend on type of fracture, size and location of the intraarticular fragments, and degree of comminution of the extra-articular component. Ninety-one pilon fractures (90 patients) underwent minimally invasive reduction and fixation, of which 7 fractures (7.69%), required open reduction because of intraoperative failure to achieve anatomic reduction. Of the 84 fractures that underwent successful minimally invasive reduction and fixation reported, 35 fractures (41.7%) with excellent outcomes, 40 fractures (47.6%) with good outcomes, 6 fractures (7,1%) with fair outcomes, and 3 fractures (3.6%) had poor outcomes for the long-term American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score (follow-up ≥ 60 months). These results prove that minimally invasive treatment is an effective and durable treatment option for intra-articular pilon fractures. We encourage future clinical studies to further refine minimally invasive techniques for pilon fractures to improve outcomes.
胫骨平台骨折常伴有明显的关节软骨和软组织损伤。合并症的存在与手术部位并发症的风险增加有关。随着手术技术和植入物的改进，并发症发生率有所下降；然而，总体预后往往仍然较差。本研究的目的是评估基于 CT 分类的创新微创复位和固定技术治疗胫骨平台骨折的结果，并比较短期和长期结果的差异。根据术前 CT 发现，骨折分为内翻、外翻、前、后和中立型。微创复位和固定技术取决于骨折类型、关节内碎片的大小和位置以及关节外部分的粉碎程度。91 例（90 例患者）PILON 骨折采用微创复位和固定，其中 7 例（7.69%）因术中未能达到解剖复位而需要切开复位。在成功进行微创复位和固定的 84 例报告中，35 例（41.7%）有极好的结果，40 例（47.6%）有良好的结果，6 例（7.1%）有中等的结果，3 例（3.6%）有差的结果，长期美国矫形足踝协会（AOFAS）踝关节-后足评分（随访≥60 个月）。这些结果证明微创治疗是治疗关节内 PILON 骨折的有效且持久的治疗选择。我们鼓励未来的临床研究进一步完善 PILON 骨折的微创技术，以提高治疗效果。
