Hill D S, Davis J R
Torbay and South Devon NHS Foundation Trust, UK.
Ann R Coll Surg Engl. 2025 Apr;107(4):268-274. doi: 10.1308/rcsann.2024.0063. Epub 2024 Dec 13.
Pilon fractures are potentially limb-threating injuries. Staged soft tissue damage control is described, but actual practices are unknown. We report a national trainee collaborative evaluating how tibial Pilon fractures are acutely managed.
ENFORCE was a multicentre retrospective observational study of the acute management of tibial Pilon fractures over a three-year period. Mechanism of injury, imaging, fracture classification, time to cast application, soft tissue damage control strategy and definitive management details were determined.
A total of 656 patients (670 fractures) across 27 centres were reported. AO fracture classifications were: partial articular (=294) and complete articular (=376). Initial diagnostic imaging mobilities were plain radiographs (=602) and a trauma computed tomography (CT) scan (=54). A total of 526 fractures had a cast applied in the emergency department (91 before radiological diagnosis), with the times taken to obtain postcast imaging being: mean 2.7 hours, median 2.3 hours and range 28 minutes-14 hours. 35% (102/294) of partial articular and 57% (216/376) of complete articular fractures had a spanning external fixator applied, all of which underwent a planning CT scan. Definitive management consisted of open reduction internal fixation (=495), fine wire frame (=86), spanning external fixator (=25), intramedullary nail (=25) or other (=18).
The management of tibial Pilon fractures is variable, with just over half of complete articular fractures managed with the gold standard 'span, scan, plan' staged soft tissue resuscitation. A national standard of care would increase the profile and standardise management of these potentially limb-threatening injuries, together with setting them apart from more straightforward ankle fractures.
Pilon骨折可能会对肢体造成威胁。虽然描述了分期软组织损伤控制，但实际做法尚不清楚。我们报告了一项全国性的实习生合作研究，评估胫骨Pilon骨折的急性处理方式。
ENFORCE是一项为期三年的多中心回顾性观察研究，旨在研究胫骨Pilon骨折的急性处理。确定了损伤机制、影像学检查、骨折分类、应用石膏的时间、软组织损伤控制策略以及最终处理细节。
共报告了27个中心的656例患者（670处骨折）。AO骨折分类为：部分关节内骨折（=294例）和完全关节内骨折（=376例）。初始诊断影像学检查包括普通X线片（=602例）和创伤计算机断层扫描（CT）（=54例）。共有526处骨折在急诊科应用了石膏（91例在放射学诊断之前），应用石膏后进行影像学检查的时间为：平均2.7小时，中位数2.3小时，范围为28分钟至14小时。35%（102/294）的部分关节内骨折和57%（216/376）的完全关节内骨折应用了跨越性外固定架，所有这些骨折均进行了计划CT扫描。最终处理包括切开复位内固定（=495例）、细钢丝框架固定（=86例）、跨越性外固定架固定（=25例）、髓内钉固定（=25例）或其他（=18例）。
胫骨Pilon骨折的处理方式各不相同，超过一半的完全关节内骨折采用金标准的“跨越、扫描、计划”分期软组织复苏方法进行处理。全国性的护理标准将提高这些可能威胁肢体的损伤的关注度并使其处理标准化，同时将它们与更简单的踝关节骨折区分开来。
