Department of Orthopedic Surgery, Foot and Ankle Unit, Hospital del Trabajador, Santiago, Chile; Centro de Excelencia en Reconstrucción Ósea, Santiago, Chile.
Department of Orthopedic Surgery, Foot and Ankle Unit, Hospital de Puerto Montt; Clínica Andes Salud Puerto Montt, Puerto Montt, Chile.
Injury. 2023 Nov;54 Suppl 6:110884. doi: 10.1016/j.injury.2023.110884.
Controversy exists regarding the optimal management of AO/OTA 43. C3 pilon fractures. Open reduction and internal fixation (ORIF) is the gold standard treatment, but serious soft tissue and infectious complications have been previously reported. Minimally invasive strategies using hexapod ring fixation (HRF) with supplemental limited internal fixation have been used to reduce the incidence of complications. Previous studies have included heterogeneous types of pilon fractures, with non-comminuted injuries being more likely to be treated with ORIF and complex fractures receiving HRF treatment. To our knowledge, no studies have compared the complications and reoperation rates between ORIF and HRF exclusively for C3 fractures.
Retrospective study comparing 53 patients treated for AO/OTA 43.C3 pilon fracture with ORIF or HRF in a trauma level I center with at least a two-year follow-up. Patients treated between January 2015 and January 2019 received ORIF and those treated between January 2019 and January 2021 received HRF. Complications were divided into two groups: minor (superficial infection and malalignment) and major (non-union, deep infection, and amputation). Reoperations, prevalence of ankle osteoarthritis, and requirement for ankle arthrodesis/total ankle replacement were registered.
We included 30 and 23 patients in the ORIF and HRF groups, respectively. The overall complication rate was similar in both groups, with 50% and 56,5% of the patients having complications in the ORIF and HRF groups, respectively (p:0,63). Minor complications were significantly more prevalent in the HRF group (p<0,001) whilst the ORIF group had a significantly higher rate of major complications (p<0,01). Superficial infections were highly prevalent in the HRF group (47,8%), as they were related to half-pin or K-wire infections. Deep infection was present only in the ORIF group, with 20% of the patients developing this major complication (p:0,03). Non-union rate, reoperations, ankle osteoarthritis, and the need for arthrodesis or ankle replacement showed no significant differences.
In AO/OTA 43.C3 fractures, HRF is safe and effective, achieving high union rates with a significantly lower rate of major complications compared to ORIF. According to our results, ORIF should be used cautiously for these types of fractures, considering the increased risk of deep infection.
对于 AO/OTA 43.C3 型 Pilon 骨折，最佳治疗方法存在争议。切开复位内固定（ORIF）是金标准治疗方法，但此前有报道称其存在严重的软组织和感染并发症。使用六足环固定（HRF）和辅助有限内固定的微创策略已被用于降低并发症的发生率。既往研究包括异质性 Pilon 骨折类型，非粉碎性损伤更倾向于接受 ORIF 治疗，而复杂骨折则接受 HRF 治疗。据我们所知，尚无研究专门比较 ORIF 和 HRF 治疗 C3 型骨折的并发症和再次手术率。
回顾性研究比较了 53 例在创伤 I 级中心接受 ORIF 或 HRF 治疗的 AO/OTA 43.C3 Pilon 骨折患者，随访时间至少 2 年。2015 年 1 月至 2019 年 1 月接受 ORIF 治疗的患者和 2019 年 1 月至 2021 年 1 月接受 HRF 治疗的患者。并发症分为两组：轻微（浅表感染和对线不良）和严重（骨不连、深部感染和截肢）。记录再次手术、踝关节骨关节炎的发生率以及踝关节融合/全踝关节置换的需求。
我们纳入了 ORIF 组和 HRF 组各 30 例和 23 例患者。两组的总体并发症发生率相似，ORIF 组和 HRF 组的并发症发生率分别为 50%和 56.5%（p：0.63）。HRF 组的轻微并发症明显更为常见（p<0.001），而 ORIF 组的严重并发症发生率明显更高（p<0.01）。HRF 组的浅表感染发生率很高（47.8%），因为这些感染与半钉或 K 线有关。深部感染仅见于 ORIF 组，20%的患者出现这种严重并发症（p：0.03）。骨不连率、再次手术、踝关节骨关节炎以及融合或踝关节置换的需求无显著差异。
在 AO/OTA 43.C3 型骨折中，HRF 是安全有效的，与 ORIF 相比，其具有更高的愈合率，严重并发症的发生率明显更低。根据我们的结果，对于此类骨折，应谨慎使用 ORIF，因为深部感染的风险增加。
