Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
J Bone Joint Surg Am. 2023 Jul 19;105(14):1123-1137. doi: 10.2106/JBJS.21.01377. Epub 2023 May 26.
➤ Pilon fractures in the younger patient population are frequently high-energy, intra-articular injuries and are associated with devastating, long-term impacts on patient-reported outcomes and health-related quality of life, as well as high rates of persistent disability.➤ Judicious management of associated soft-tissue injury, including open fractures, is essential to minimizing complications. Optimizing medical comorbidities and negative social behaviors (e.g., smoking) should be addressed perioperatively.➤ Delayed internal fixation with interval temporizing external fixation represents the preferred technique for managing most high-energy pilon fractures presenting with characteristically substantial soft-tissue trauma. In some cases, surgeons elect to utilize circular fixation for these scenarios.➤ Although there have been treatment advances, the results have been generally poor, with high rates of posttraumatic arthritis, despite expert care.➤ Primary arthrodesis may be indicated in cases with severe articular cartilage injury that, in the opinion of the treating surgeon, is likely unsalvageable at the time of the index management.➤ The addition of intrawound vancomycin powder at the time of definitive fixation represents a low-cost prophylactic measure that appears to be effective in reducing gram-positive deep surgical site infections.
➤ 在年轻患者群体中，Pilon 骨折通常是高能量的关节内损伤，与患者报告的结果和健康相关的生活质量的毁灭性长期影响以及持续残疾率高有关。➤ 明智地管理相关的软组织损伤，包括开放性骨折，对于最大限度地减少并发症至关重要。应在围手术期解决合并症和负面社会行为（例如吸烟）。➤ 对于大多数伴有明显大量软组织创伤的高能 Pilon 骨折，延迟的内固定和间隔临时外固定是首选技术。在某些情况下，外科医生选择在这些情况下使用环形固定。➤ 尽管治疗方法有所进步，但结果普遍较差，尽管接受了专家治疗，但仍有很高的创伤后关节炎发生率。➤ 在主治外科医生认为严重关节软骨损伤不可挽救的情况下，可能需要进行一期关节融合术。➤ 在确定性固定时加入伤口内万古霉素粉末是一种低成本的预防措施，似乎可有效降低革兰氏阳性深部手术部位感染。
