Shrivastava Nayan, Mannan Muhammad, Hamid Muhammad A, Akbar Rizwan, Prabhu Rudra M
Trauma and Orthopedic, Sancheti Institute for Orthopaedic and Rehabilitation, Pune, IND.
Trauma and Orthopaedics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, GBR.
Cureus. 2024 Nov 30;16(11):e74867. doi: 10.7759/cureus.74867. eCollection 2024 Nov.
This study aimed to evaluate the functional outcomes of three surgical management strategies for pilon fractures, including primary external fixation with delayed plating, external fixation with minimal internal fixation, and single-stage open reduction and internal fixation (ORIF) with plating.
This prospective cohort study included 34 patients with complex intra-articular fractures of the distal tibia (AO-OTA type 43-C) treated between June 2018 and December 2019. Patients were managed surgically based on the local skin condition and swelling, employing either primary-stage external fixation with delayed plating (Group A), external fixation with minimal internal fixation (Group B), or single-stage ORIF with plating (Group C). Patients were followed up at regular intervals (six weeks, three months, six months, and 12 months post-surgery). Functional outcomes were assessed using the American Orthopaedic Foot and Ankle Society Hindfoot Score (AOFAS) and Foot and Ankle Disability Index (FADI). Statistical significance was set at p<0.05.
The mean age of patients was 41±12.34 years. Group C included 23 patients (67.7%), Group B included five patients (14.7%), and Group A included six patients (17.6%). There were no significant differences between groups regarding the mechanism of injury, hospital stay duration, complications, or final functional scores (p>0.05). Group C showed significantly better AOFAS and FADI scores at six weeks and three months compared to the other groups; however, by six and 12 months, no significant differences were observed between the groups.
While ORIF with plating (Group C) demonstrated superior short-term functional outcomes, no long-term differences were observed between the three surgical approaches for pilon fractures. These findings suggest that all three methods can be viable options, with choice depending on individual patient factors and surgeon preference.
本研究旨在评估三种手术治疗策略用于pilon骨折的功能结局，包括一期外固定并延期钢板内固定、有限内固定结合外固定以及一期切开复位钢板内固定（ORIF）。
这项前瞻性队列研究纳入了2018年6月至2019年12月期间接受治疗的34例胫骨远端复杂关节内骨折（AO-OTA 43-C型）患者。根据局部皮肤状况和肿胀情况对患者进行手术治疗，采用一期外固定并延期钢板内固定（A组）、有限内固定结合外固定（B组）或一期ORIF（C组）。定期（术后6周、3个月、6个月和12个月）对患者进行随访。使用美国矫形足踝协会后足评分（AOFAS）和足踝残疾指数（FADI）评估功能结局。设定统计学显著性水平为p<0.05。
患者的平均年龄为41±12.34岁。C组有23例患者（67.7%），B组有5例患者（14.7%），A组有6例患者（17.6%）。在损伤机制、住院时间、并发症或最终功能评分方面，各组之间无显著差异（p>0.05）。与其他组相比，C组在术后6周和3个月时AOFAS和FADI评分明显更好；然而，到6个月和12个月时，各组之间未观察到显著差异。
虽然钢板内固定的ORIF（C组）显示出较好的短期功能结局，但三种pilon骨折手术方法之间未观察到长期差异。这些发现表明，所有三种方法都是可行的选择，具体选择取决于个体患者因素和外科医生的偏好。
