Department of Orthopaedic Surgery, National University Hospital, National University Health System, Singapore.
Foot Ankle Surg. 2022 Oct;28(7):891-897. doi: 10.1016/j.fas.2021.12.007. Epub 2021 Dec 21.
There is a lack of consensus about the role of fibula fixation in these complex fractures, with only two clinical studies in the literature. We hypothesize that the fibula fracture need not be fixed in the tibial pilon fractures if primary stability can be achieved with tibial fixation alone.
We reviewed 79 patients with operatively treated tibial pilon with associated fibula fractures from 2007 to 2017 and divided them into two groups; patients with fibula fracture fixation and those without fixation. The primary outcome measure was any mechanical complications. Secondary outcomes were wound complications and other morbidities.
There were 54 (68.4%) patients with fibula fixation and 25 (31.6%) patients without fixation. There were no statistically significant differences in mechanical complications between the two groups. However, patients without fibula fixation were noted to have more wound complications (44% vs 25.9%, p = 0.108) although this was not statistically significant. In terms of removal of implant (ROI), there were no differences noted in patients with or without fibula fixation (33.3% vs 28%, p = 0.796). There were also no significant differences in ROI for those fixed with plate and screws when compared to those fixed with Rush rod and K wire within the group with fibula fixation.
Fibula fixation in the treatment of tibial pilon fractures is not routinely necessary and does not result in decreased mechanical complications such as malunion, delayed union, nonunion and implant failure. Fibula fracture fixation should be reserved for cases where it may aid reduction or provide additional stability.
对于这些复杂的骨折，腓骨固定的作用缺乏共识，文献中仅有两项临床研究。我们假设，如果胫骨固定能够实现初步稳定性，则胫骨 pilon 骨折患者的腓骨骨折无需固定。
我们回顾了 2007 年至 2017 年期间手术治疗的伴有腓骨骨折的 79 例胫骨 pilon 骨折患者，并将其分为两组；腓骨骨折固定组和未固定组。主要观察指标为任何机械并发症。次要观察指标为伤口并发症和其他并发症。
54 例（68.4%）患者行腓骨固定，25 例（31.6%）患者未行腓骨固定。两组间机械并发症无统计学差异。然而，未行腓骨固定的患者伤口并发症更多（44%比 25.9%，p=0.108），但无统计学意义。在植入物取出（ROI）方面，行或不行腓骨固定的患者间无差异（33.3%比 28%，p=0.796）。在腓骨固定组中，与使用钢板和螺钉固定的患者相比，使用 Rush 棒和 K 线固定的患者的 ROI 也无显著差异。
在治疗胫骨 pilon 骨折时，常规行腓骨固定并非必要，且不会降低诸如畸形愈合、延迟愈合、不愈合和植入物失败等机械并发症的发生率。腓骨骨折固定应保留在可能有助于复位或提供额外稳定性的情况下。
