Yixing People's Hospital and Department of Orthopaedic Center, Wuxi, Jiangsu, China.
Zhuhai People's Hospital (Zhuhai Clinical Medical College of Jinan University) and Department of Orthopaedics, Zhuhai, Guangdong, China.
Medicine (Baltimore). 2024 Aug 16;103(33):e39151. doi: 10.1097/MD.0000000000039151.
Central collapsed fracture blocks traditionally require either an anteromedial or anterolateral approach for reduction. However, existing techniques face challenges such as soft tissue damage and compromised tibial strength, especially in pilon fractures with central articular surface collapse and an intact anterior cortex, as classified under 43B2.3 in the 2018 Orthopaedic Trauma Association/Association for the Study of Internal Fixation Fracture and Dislocation Classification Compendium.
We address the management of pilon fractures with central articular surface collapse, focusing on 2 cases where conventional reduction techniques posed a risk to soft tissues and tibial integrity.
The patients presented with pilon fractures characterized by a central articular surface collapse and an intact anterior cortex, aligning with the 43B2.3 classification.
A novel approach was employed, utilizing posterior tibial fenestration and indirect reduction with compression techniques. This method leveraged the talus as a template for precise articular surface realignment.
Both cases demonstrated excellent reduction of the distal tibial articular surface and achieved favorable functional recovery of the ankle, evidenced by high American Orthopedic Foot and Ankle Society Ankle Hindfoot Scale scores during the 3-year follow-up.
The posterior tibial fenestration technique offers significant advantages for distal tibial pilon fracture reduction. It allows for precise articular realignment, facilitates bone grafting, and minimizes soft tissue and cortical bone disruption. This method is particularly effective for pilon fractures with an intact anterolateral cortex and central articular collapse, providing a valuable surgical alternative.
传统上，中央塌陷骨折块需要通过前内侧或前外侧入路进行复位。然而，现有的技术面临着诸如软组织损伤和胫骨强度受损等挑战，尤其是在 2018 年骨科创伤协会/内固定骨折和脱位分类汇编中分类为 43B2.3 的中央关节面塌陷和完整前皮质的 Pilon 骨折中。
我们解决了中央关节面塌陷的 Pilon 骨折的处理问题，重点关注了 2 例采用传统复位技术会对软组织和胫骨完整性造成风险的病例。
患者表现为中央关节面塌陷和完整前皮质的 Pilon 骨折，符合 43B2.3 分类。
采用了一种新的方法，即利用后胫骨开窗和间接压缩技术进行复位。该方法利用距骨作为精确关节面复位的模板。
这两个病例均显示出良好的远端胫骨关节面复位，踝关节功能恢复良好，在 3 年的随访中，美国矫形足踝协会踝关节后足评分均较高。
后胫骨开窗技术为远端胫骨 Pilon 骨折复位提供了显著优势。它允许精确的关节复位，便于植骨，并最大限度地减少软组织和皮质骨的破坏。对于前外侧皮质和中央关节塌陷完整的 Pilon 骨折，该方法特别有效，为手术提供了一种有价值的选择。
