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Stojiljkovic P, Milenkovic S, Velickov A, Mitkovic M. [The role of capsuloligamentotaxis and minimally invasive percutaneous osteosynthesis with rigid and dynamic unilateral external fixation of the intra-articular pilon fracture]. Unfallchirurgie (Heidelb) 2024; 127:246-250. [PMID: 37801096 DOI: 10.1007/s00113-023-01373-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 10/07/2023]
Abstract
Fractures of the tibial pilon are severe injuries which can be accompanied by articular impaction, comminution and soft tissue injury. Soft tissue injury with already existing skin damage can further complicate the method of treatment. In these cases, the method of unilateral or circular external fixation can be used as an alternative method of treatment. Minimally invasive percutaneous osteosynthesis with spanning rigid and dynamic unilateral external fixation as a one-stage method has been used for the treatment of intra-articular pilon fractures. We report a case of a patient with an intra-articular pilon fracture with chronic venous insufficiency and venous ulcer, who was injured after falling from a height and who had emergency surgery based on capsuloligamentotaxis and percutaneous osteosynthesis with a spanning unilateral external fixator. The patient was mobilized postoperatively for walking without weight bearing on the injured leg. The initial rigid spanning external fixation was transformed into dynamic fixation to enable ankle joint movements 8 weeks after surgery. The external fixator was removed 4.5 months after surgery and the Kirschner wire and screws were removed 7 months after surgery. The final functional result 1 year after the injury was good and motion of upper ankle joint was moderately restricted without pain. Swelling occurred after walking for longer distances.
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Affiliation(s)
- Predrag Stojiljkovic
- Universitätsklinik für Orthopädie und Traumatologie, Medizinische Fakultät, Universität Nis, Bulevar Dr Zorana Djindjica 48, 18000, Nis, Serbien
| | - Sasa Milenkovic
- Universitätsklinik für Orthopädie und Traumatologie, Medizinische Fakultät, Universität Nis, Bulevar Dr Zorana Djindjica 48, 18000, Nis, Serbien.
| | - Asen Velickov
- Universitätsklinik für Orthopädie und Traumatologie, Nis, Serbien
| | - Milan Mitkovic
- Universitätsklinik für Orthopädie und Traumatologie, Medizinische Fakultät, Universität Nis, Bulevar Dr Zorana Djindjica 48, 18000, Nis, Serbien
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Korrapati A, Ta CN, Mitchell BC, Wall PV, Gurusamy P, Dwight K, Girard PJ, Schwartz AK, Kent WT. Fracture blisters: predictors for time to definitive fixation in pilon fractures. Eur J Orthop Surg Traumatol 2024; 34:161-166. [PMID: 37386191 PMCID: PMC10771370 DOI: 10.1007/s00590-023-03623-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/17/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE Fracture blisters, a common soft-tissue complication of pilon fractures, are associated with post-operative wound infections, delays in definitive fixation, and alterations in surgical plan. The purpose of this study was to (1) identify the delay in surgery attributable to the presence fracture blisters and (2) investigate the relationship of fracture blisters to comorbidities and fracture severity. METHODS Patients with pilon fractures at an urban level 1 Trauma center from 2010 to 2021 were identified. The presence or absence of fracture blisters was noted, along with location. Demographic information, time from injury to external fixator placement, and time to definitive open reduction internal fixation (ORIF) were collected. Pilon fractures were classified according to AO/OTA guidelines using CT imaging and plain radiographs. RESULTS 314 patients with pilon fractures were available for analysis, eighty (25%) of whom were found to have fracture blisters. Patients with fracture blisters had longer time to surgery compared to those without fracture blisters (14.2 days vs 7.9 days, p < 0.001). A greater proportion of patients with fracture blisters had AO/OTA 43C fracture patterns, compared with those without fracture blisters (71.3% vs 53.8%, p = 0.03). Fractures blisters were less likely to be localized over the posterior ankle (12%, p = 0.007). CONCLUSION The presence of fracture blisters in pilon fractures are associated with significant delays in time to definitive fixation and higher energy fracture patterns. Fracture blisters are less commonly located over the posterior ankle which may support the implementation of a staged posterolateral approach when managing these injures.
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Affiliation(s)
- Avinaash Korrapati
- Department of Orthopaedic Surgery, University of California San Diego, 200 W Arbor Drive, MC 8894, San Diego, CA, 92103, USA
| | - Canhnghi N Ta
- Department of Orthopaedic Surgery, University of California San Diego, 200 W Arbor Drive, MC 8894, San Diego, CA, 92103, USA
| | - Brendon C Mitchell
- Department of Orthopaedic Surgery, University of California San Diego, 200 W Arbor Drive, MC 8894, San Diego, CA, 92103, USA
| | - Pelle V Wall
- Department of Orthopaedic Surgery, University of California San Diego, 200 W Arbor Drive, MC 8894, San Diego, CA, 92103, USA
| | - Pradyumna Gurusamy
- Department of Orthopaedic Surgery, University of California San Diego, 200 W Arbor Drive, MC 8894, San Diego, CA, 92103, USA
| | - Kathryn Dwight
- Department of Orthopaedic Surgery, University of California San Diego, 200 W Arbor Drive, MC 8894, San Diego, CA, 92103, USA
| | - Paul J Girard
- Department of Orthopaedic Surgery, University of California San Diego, 200 W Arbor Drive, MC 8894, San Diego, CA, 92103, USA
| | - Alexandra K Schwartz
- Department of Orthopaedic Surgery, University of California San Diego, 200 W Arbor Drive, MC 8894, San Diego, CA, 92103, USA
| | - William T Kent
- Department of Orthopaedic Surgery, University of California San Diego, 200 W Arbor Drive, MC 8894, San Diego, CA, 92103, USA.
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Das A, Malhotra R, Srivastava A, Tandon A, Jain AK, Aggarwal AN, Rajnish RK. Assessment of inter and intra-observer variation of Leonetti and Tigani CT bases classification of tibial pilon fractures. Int J Burns Trauma 2023; 13:51-57. [PMID: 37215507 PMCID: PMC10195221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 03/22/2023] [Indexed: 05/24/2023]
Abstract
INTRODUCTION tibial pilon fracture constitutes 5-7% of all tibial fractures. The treatment of choice is an open reduction with anatomical articular reconstruction and stable fixation. A relievable fracture classification is needed for the preoperative planning the surgical management of these fractures. Hence, we assessed the inter- and intra-observer variation of Leonetti and Tigani CT bases classification of tibial pilon fractures. MATERIALS AND METHODS In this prospective study, 37 patients aged between 18-65 years with an ankle fracture were included. All these patients underwent a CT scan for the ankle fracture, and the CT scan was further evaluated by 5 independent observers (Orthopaedic surgeon). A kappa value was determined for inter and intra-observer variation. RESULTS Leonetti and Tigani's CT-based classification of the kappa values was 0.657 to 0.751, with a mean value of 0.700. The range of values for the intra-observer variation using Leonetti and Tigani CT-based classification on the kappa values was 0.658 to 0.875 with a mean value of 0.755. The P-value < 0.001 states that there was a significant agreement between the inter-observer and intra-observer classification. CONCLUSION Leonetti and Tigani Classification have shown substantial inter- and intra-observer agreement, and the "4B" subclass of Leonetti and Tigani CT-based classification showed a predominance in the present study.
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Affiliation(s)
- Alok Das
- Department of Orthopaedics, University College of Medical Sciences & GTB HospitalDelhi, India
| | - Raskesh Malhotra
- Department of Orthopaedics, University College of Medical Sciences & GTB HospitalDelhi, India
| | - Amit Srivastava
- Department of Orthopaedics, University College of Medical Sciences & GTB HospitalDelhi, India
| | - Anupama Tandon
- Department of Radiology, University College of Medical Sciences & GTB HospitalDelhi, India
| | - Anil K Jain
- Department of Orthopaedics, University College of Medical Sciences & GTB HospitalDelhi, India
| | - Aditya N Aggarwal
- Department of Orthopaedics, University College of Medical Sciences & GTB HospitalDelhi, India
| | - Rajesh Kumar Rajnish
- Department of Orthopaedics, All India Institute of Medical SciencesJodhpur, Rajasthan, India
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McClure TT, Taylor BC, Huber G, Glazier M, Myers DM, DeGenova DT. Intramedullary Screw Fixation Versus Traditional Plating for Distal Fibula Fractures. J Foot Ankle Surg 2023; 62:355-359. [PMID: 36280403 DOI: 10.1053/j.jfas.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 08/19/2022] [Accepted: 09/10/2022] [Indexed: 02/03/2023]
Abstract
The traditional method of treating fibular fractures in unstable ankle injuries involves open reduction and internal fixation with a plate and screw construct. Less invasive percutaneous fixation techniques with intramedullary fibular screws have been utilized for many years to reduce wound and implant complications while maintaining a stable ankle mortise. However, there have been no direct case-control studies comparing percutaneous intramedullary fibular screw fixation to the traditional open reduction and internal fixation with plates and screws. In our study, we compared radiographic and clinical outcomes for unstable ankle fractures in which the fibula fracture was treated with either a percutaneous intramedullary screw or by open reduction and internal fixation with a plate and screw construct. We retrospectively reviewed 69 consecutive patients from 2011 to 2019 with unstable ankle fractures treated with intramedullary fibular screws and compared them to 216 case-control patients treated with traditional plate and screw construct over the same time period. The average follow-up for the intramedullary screw group was 11.5 months and 15.2 months for the plate and screw group. We collected general demographic data, measured intraoperative and final follow-up talocrural angles, Kellgren-Lawrence osteoarthritis grade, union rates, implant removal rates, infection rates, and American Orthopedic Foot and Ankle Society ankle-hindfoot scores. The intramedullary screw group had a statistically significant lower rate of delayed implant removal (8.7% vs 23.6%) and there was no detectable difference in other measures.
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Affiliation(s)
| | - Benjamin C Taylor
- Orthopaedic Trauma and Reconstructive Surgery, Department of Orthopedic Surgery, Grant Medical Center, Columbus, OH
| | - Grant Huber
- Ohio University Heritage College of Osteopathic Medicine, Athens, OH
| | | | - Devon M Myers
- Department of Orthopedic Surgery, OhioHealth, Columbus, OH
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Sousa A, Carvalho J, Amorim J, Rodrigues-Pinto R. Incidence and clinical results of tendinous injuries in calcaneus and pilon fractures. Arch Orthop Trauma Surg 2023; 143:359-63. [PMID: 35041080 DOI: 10.1007/s00402-022-04343-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 01/04/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The aims of this study were: (1) to define the incidence of tendinous injuries in calcaneus and pilon fractures with different fracture severity and (2) to determine the clinical impact of such injuries. STUDY DESIGN AND METHODS CT-scans of 121 patients with calcaneus and pilon fractures were retrospectively analyzed over a 4-year period. The tendinous injuries were identified and correlated with the type of fracture (location and classification). Clinical analysis was performed using the American Orthopedic Foot and Ankle Society (AOFAS) and SF-36 (Short Form-36 Health Survey) scores. RESULTS Tendinous injuries were observed in 36% of all CT-scans analyzed, with the most common injury being incarceration (n = 20) and dislocation (n = 24). Calcaneus fractures sanders type 3/4 were 9 times more prone to tendon injury (p < 0.001; OR 8.67; 95% CI 2.49-30.24). Pilon fractures Ruedi-Allgower type 2/3 were 8 times more prone to tendon injury (p = 0.005; OR 7.5; 95% CI 1.72-32.80). No significant differences (p > 0.05) were found in AOFAS and SF-36 scores between patients with/without tendon injuries for fractures with the same severity. CONCLUSION The incidence of tendon injuries in calcaneus/pilon fractures is high and may be underreported. Calcaneus fractures are prone to peroneal tendon injury. In pilon fractures, it is important to look for tibialis posterior tendon injury, especially entrapment. The presence of tendinous injuries does not affect function and pain for the same type of calcaneus and pilon fractures at the long term. LEVEL OF EVIDENCE Level 3 retrospective study.
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Houben M, van Hoeve S, Leenstra BS, Willems P, Meijer K, Poeze M. Gait analysis and clinical outcome in patients after pilon fracture surgery. Foot Ankle Surg 2022; 28:1229-1234. [PMID: 35562225 DOI: 10.1016/j.fas.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/24/2022] [Accepted: 04/14/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND In this study kinematic parameters, radiographic findings and PROM in pilon fractures after operative treatment were compared with healthy subjects. METHODS 16 patients treated with osteosynthesis after pilon fracture underwent kinematic analysis with the OFM. Fractures were evaluated for post-operative step-off and gap on CT-scans and PROM were collected. Results were compared to 10 healthy persons. RESULTS Range of motion (ROM) crural was lower in the flexion/extension for pilon fractures (10.03 vs. 13.15, p = 0.017). The ROM in the inversion/eversion was low, but ROM in the abduction/adduction was higher. Correlations were found between flexion/extension and AO-classification (r = -0.357 p < 0.05), PROM score of the AOFAS (r = 0.445 p < 0.01), post-operative gap and step-off in the tibia plafond. CONCLUSION Pilon fractures showed decreased ROM between the hindfoot and tibia in the sagittal and transverse plane, but increased ROM in the frontal plane during push-off phase as compensatory kinetics. ROM showed significant correlations with PROM and intra-articular step-off and gap in the tibia plafond.
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Affiliation(s)
- Michaël Houben
- Department of Surgery, division of Trauma surgery, Maastricht University Medical Center. P. Debyelaan 251. PO Box 5800, 6202 AZ Maastricht, The Netherlands.
| | - Sander van Hoeve
- Department of Surgery, division of Trauma surgery, Maastricht University Medical Center. P. Debyelaan 251. PO Box 5800, 6202 AZ Maastricht, The Netherlands.
| | - Bernard S Leenstra
- Department of Surgery, division of Trauma surgery, Maastricht University Medical Center. P. Debyelaan 251. PO Box 5800, 6202 AZ Maastricht, The Netherlands.
| | - Paul Willems
- Department of Movement Sciences, Maastricht University Medical Center, P. Debyelaan 25. PO Box 616, 6200 MD Maastricht, The Netherlands; NUTRIM, School for Nutrition and Translational Research in Metabolism, PO Box 616, 6200 MD Maastricht, The Netherlands.
| | - Kenneth Meijer
- Department of Movement Sciences, Maastricht University Medical Center, P. Debyelaan 25. PO Box 616, 6200 MD Maastricht, The Netherlands; NUTRIM, School for Nutrition and Translational Research in Metabolism, PO Box 616, 6200 MD Maastricht, The Netherlands.
| | - Martijn Poeze
- Department of Surgery, division of Trauma surgery, Maastricht University Medical Center. P. Debyelaan 251. PO Box 5800, 6202 AZ Maastricht, The Netherlands; NUTRIM, School for Nutrition and Translational Research in Metabolism, PO Box 616, 6200 MD Maastricht, The Netherlands.
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Huang M, Wang Q, Guan J, Liu K, Chen Y, Wang L. Tips and Tricks in surgical reduction of the posterior column of AO/OTA C3 pilon fractures. BMC Musculoskelet Disord 2022; 23:2. [PMID: 34980071 PMCID: PMC8725567 DOI: 10.1186/s12891-021-04890-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Accurate posterior column reduction remains a challenging and controversial topic in the management of complex pilon fractures (AO/OTA C3). We aim to report the outcomes of surgical treatment for 22 AO/OTA C3 pilon fracture cases between January 2015 and May 2017 and highlight some traps and tips. METHODS Three patients underwent two-stage early plating on the posterior column through a posterolateral approach. The remaining 19 patients were treated with two-stage delayed plating on the posterior column: 11 patients were treated with a posterolateral approach, five patients with a modified posteromedial approach, and three patients with a single anterior approach. The reduction of the posterior column was evaluated according to the Burwell-Charnley's radiographic criteria, and functional outcomes were assessed using the American Orthopedic Foot and Ankle Society (AOFAS) scores. RESULTS Posterior column malreduction occurred in five cases, including in one case that was re-adjusted immediately and in another case that was re-adjusted during a two-staged delayed operation. According to Burwell-Charnley's criteria, the satisfactory rate of fracture reduction was 81.8%. After 1 year, the mean AOFAS score was 81.9 (81.9 ± 9.9); the outcome was excellent in three (20.0%), good in nine (60.0%), and fair in three (20.0%). Excellent or good outcomes were noted in 12 patients (80.0%). CONCLUSIONS The combined anterior and posterior approach is suggested in the second stage of plating so that the posterior column fragments can be re-adjusted intraoperatively, if necessary. Following these procedures, satisfactory reduction and recovery of good ankle function can be anticipated.
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Affiliation(s)
- Moran Huang
- Department of Orthopedic Surgery, and Shanghai Institute of Microsurgery on Extremities, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Qiuke Wang
- Department of Orthopedic Surgery, and Shanghai Institute of Microsurgery on Extremities, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Junjie Guan
- Department of Orthopedic Surgery, and Shanghai Institute of Microsurgery on Extremities, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Kexin Liu
- Department of Orthopedic Surgery, and Shanghai Institute of Microsurgery on Extremities, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yunfeng Chen
- Department of Orthopedic Surgery, and Shanghai Institute of Microsurgery on Extremities, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
| | - Lei Wang
- Department of Orthopedic Surgery, and Shanghai Institute of Microsurgery on Extremities, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
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Malhotra G, Al Bahri ZH, Elsayed AOA, Komma VNR, Patil R. Hemihamate arthroplasties in pilon fractures: a modified approach and experience in 30 patients. J Hand Surg Eur Vol 2021; 46:928-935. [PMID: 33904323 DOI: 10.1177/17531934211008056] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Hemihamate arthroplasty is an established method of managing difficult Pilon fractures of the proximal interphalangeal (PIP) joint. We present our experience in 30 patients, whose injuries were further complicated by severe comminution and late presentations. Several modifications were utilized, including preoperative distraction, use of smaller size grafts and functional release of collaterals. The average follow-up period was 28 months (range 18 to 28). Postoperatively, the average range of flexion at the PIP joint improved from 30° (range 20° to 45°) preoperatively to 104° (90° to 110°) at the final follow-up. The average extension lag was 6° (0° to 20°). Five patients required secondary procedures and no patient had a recurrent dorsal dislocation. We propose these modifications in the use of hemihamate arthroplasty for the management of difficult PIP joint fractures.Level of evidence: IV.
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Affiliation(s)
- Gopal Malhotra
- Department of Hand and Microvascular Surgery, Khoula Hospital, Muscat, Sultanate of Oman
| | - Zamzam Hamed Al Bahri
- Department of Hand and Microvascular Surgery, Khoula Hospital, Muscat, Sultanate of Oman
| | | | | | - Rahul Patil
- Department of Hand and Microvascular Surgery, Khoula Hospital, Muscat, Sultanate of Oman
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Ramlee MH, Seng GH, Ros Felip A, Abdul Kadir MR. The effects of additional hollow cylinder coated to external fixator screws for treating pilon fracture: A biomechanical perspective. Injury 2021; 52:2131-41. [PMID: 33745700 DOI: 10.1016/j.injury.2021.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 03/02/2021] [Accepted: 03/05/2021] [Indexed: 02/02/2023]
Abstract
An external fixator is a promising medical device that could provide optimum stability and reduce the rate of complications in treating bone fracture during intervention period. It is noted that the biomechanics behaviour of device can be altered by introducing more features such as material suitability and additional components. Therefore, this study was conducted via finite element method to investigate the effects of additional hollow cylinder coated with external fixator screws in treating Type III pilon fracture. Finite element models which have been validated with experimental data were used to simulate stresses at the pin-bone interface and relative micromovement at interfragmentary fractures during swing (70 N load) and stance phases (350 N load). All bones and external fixators were assigned with isotropic material properties while the cartilages were simulated with hyper-elastic. For the hollow cylinder, polyethylene was assigned due to its properties which are equivalent to the bone. From the results, it is found that stresses at the pin-bone interface for the coated screws were reduced to 54% as compared to the conventional fixator. For the micromovement, there was no difference between both models, whereby the value was 0.03 mm. The results supported previously published literature, in which high stresses are unavoidable at the interface, fortunately, those stresses did not exceed the ultimate strength of bone, which is safe for treating patients. In conclusion, if patients are allowed to bear weight bearing, the external fixator with coated screws is a more favourable option to be fixed into the bone to avoid complications at the interface.
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Van Rysselberghe NL, Campbell ST, Goodnough LH, Salazar BP, Bishop JA, Bellino MJ, Lucas JF, Gardner MJ. Metaphyseal callus formation in pilon fractures is associated with loss of alignment: Is stiffer better? Injury 2021; 52:977-81. [PMID: 33097204 DOI: 10.1016/j.injury.2020.10.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/16/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the relationship between metaphyseal callus formation and preservation of distal tibial alignment in pilon fractures treated with internal plate fixation. DESIGN Retrospective Review SETTING: Academic Level I Trauma Center PATIENTS: Forty-two patients with AO/OTA type C2 or C3 pilon fractures treated with plate fixation. INTERVENTION Internal fixation with anterolateral plating, medial plating, or both. Modified Radiographic Union Score in Tibial fracture (mRUST) scores were determined from six-month radiographs. MAIN OUTCOME MEASUREMENTS Change in lateral and anterior distal tibial angles (LDTA and ADTA) at six months post-operatively. RESULTS High callus formation (mRUST ≥ 11 at six months) was associated with a greater loss of coronal reduction as measured by LDTA compared to low callus formation (mRUST < 11): 3.8 vs 2.1° (p = .019), with no difference in ADTA change between groups. In a multivariable logistic regression controlling for age, smoking, obesity, and open fracture, higher mRUST scores were a predictor of coronal reduction loss of five or more degrees (OR 1.71, p=.039). Dual column plating did not independently predict maintenance of alignment. CONCLUSIONS Recent literature has popularized dual column fixation for pilon fractures, but it remains unknown whether increased metaphyseal stiffness enhances or impairs healing. In this series, decreased metaphyseal callus formation was associated with maintained coronal alignment, suggesting that a stiffer mechanical environment may be preferable to prevent short term reduction loss in these complex injuries. LEVEL OF EVIDENCE III.
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Schnetzke M, El Barbari J, Schüler S, Swartman B, Keil H, Vetter S, Gruetzner PA, Franke J. Vascular impulse technology versus elevation for the reduction of swelling of lower extremity joint fractures: results of a prospective randomized controlled study. Bone Joint J 2021; 103-B:746-754. [PMID: 33789481 PMCID: PMC9950846 DOI: 10.1302/0301-620x.103b4.bjj-2020-1260.r1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Complex joint fractures of the lower extremity are often accompanied by soft-tissue swelling and are associated with prolonged hospitalization and soft-tissue complications. The aim of the study was to evaluate the effect of vascular impulse technology (VIT) on soft-tissue conditioning in comparison with conventional elevation. METHODS A total of 100 patients were included in this prospective, randomized, controlled monocentre study allocated to the three subgroups of dislocated ankle fracture (n = 40), pilon fracture (n = 20), and intra-articular calcaneal fracture (n = 40). Patients were randomized to the two study groups in a 1:1 ratio. The effectiveness of VIT (intervention) compared with elevation (control) was analyzed separately for the whole study population and for the three subgroups. The primary endpoint was the time from admission until operability (in days). RESULTS The mean length of time until operability was 8.2 days (SD 3.0) in the intervention group and 10.2 days (SD 3.7) in the control group across all three fractures groups combined (p = 0.004). An analysis of the subgroups revealed that a significant reduction in the time to operability was achieved in two of the three: with 8.6 days (SD 2.2) versus 10.6 days (SD 3.6) in ankle fractures (p = 0.043), 9.8 days (SD 4.1) versus 12.5 days (SD 5.1) in pilon fractures (p = 0.205), and 7.0 days (SD 2.6) versus 8.4 days (SD 1.5) in calcaneal fractures (p = 0.043). A lower length of stay (p = 0.007), a reduction in pain (ppreop = 0.05; pdischarge < 0.001) and need for narcotics (ppreop = 0.064; ppostop = 0.072), an increased reduction in swelling (p < 0.001), and a lower revision rate (p = 0.044) could also be seen, and a trend towards fewer complications (p = 0.216) became apparent. CONCLUSION Compared with elevation, VIT results in a significant reduction in the time to achieve operability in complex joint fractures of the lower limb. Cite this article: Bone Joint J 2021;103-B(4):746-754.
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Affiliation(s)
- Marc Schnetzke
- German Joint Centre Heidelberg, ATOS Clinic Heidelberg, Heidelberg, Germany,Department for Traumatology and Orthopaedics, BG Trauma Centre Ludwigshafen, Ludwigshafen, Germany,Correspondence should be sent to Marc Schnetzke. E-mail:
| | - Jan El Barbari
- Department for Traumatology and Orthopaedics, BG Trauma Centre Ludwigshafen, Ludwigshafen, Germany
| | - Svenja Schüler
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Benedict Swartman
- Department for Traumatology and Orthopaedics, BG Trauma Centre Ludwigshafen, Ludwigshafen, Germany
| | - Holger Keil
- Department for Traumatology and Orthopaedics, BG Trauma Centre Ludwigshafen, Ludwigshafen, Germany
| | - Sven Vetter
- Department for Traumatology and Orthopaedics, BG Trauma Centre Ludwigshafen, Ludwigshafen, Germany
| | - Paul Alfred Gruetzner
- Department for Traumatology and Orthopaedics, BG Trauma Centre Ludwigshafen, Ludwigshafen, Germany
| | - Jochen Franke
- Department for Traumatology and Orthopaedics, BG Trauma Centre Ludwigshafen, Ludwigshafen, Germany
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Liu T, Cheng Y, Qu W. A fibular notch approach for the treatment of ankle fractures involving the distal tibial plafond. J Orthop Surg Res 2021; 16:120. [PMID: 33557899 PMCID: PMC7869212 DOI: 10.1186/s13018-021-02270-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 01/28/2021] [Indexed: 11/22/2022] Open
Abstract
Background Although efficacy is related to many factors, the surgical approach is one of the most important intervention factors for complex ankle fractures. Ankle fractures involving the distal tibial plafond frequently present a surgical challenge in choosing which incisions will be best for surgical treatment. Here, we present an innovative fibular notch approach for the treatment of some specific ankle fractures and present a series of patients with either functional or radiographic outcomes. Methods Twenty-two patients with distal tibial plafond fractures with concomitant fibular and distal tibiofibular syndesmosis injuries were treated through a fibular notch approach in this retrospective study. The details of the surgical technique were reviewed from the operative notes. Relevant data were reviewed from the medical records. The quality of fractures and syndesmosis reduction was examined using CT scans, and lateral stability of the ankle was assessed by physical examination and stress radiographs. The American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS) score was implemented for clinical functional assessment. Results All surgeries were successfully performed via the fibular notch approach as the primary approach with excellent intraoperative visualization. Postoperative radiography revealed satisfying restoration of all fractures and syndesmosis. All fractures healed with an average time of 17.3 ± 3.6 weeks. Mild posttraumatic osteoarthritis (PTOA) was present in 4 patients. The average AOFAS score was 88.8 at the last follow-up. Conclusions The fibular notch approach is a safe and reliable approach for the treatment of specific ankle fractures involving the distal tibial plafond. This approach provides excellent direct visualization of the fragments and articular surface without significantly increasing iatrogenic injuries. Satisfactory radiographic and clinical results were observed, and further clinical and anatomical studies are recommended to ascertain the feasibility of this approach in the treatment of complex distal tibial fractures.
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Affiliation(s)
- Tong Liu
- Department of Orthopaedics, Yantaishan Hospital, NO.91 Jiefang Road, Zhifu District, Yantai, 264001, Shandong Province, China
| | - Yiheng Cheng
- Department of Orthopaedics, Yantaishan Hospital, NO.91 Jiefang Road, Zhifu District, Yantai, 264001, Shandong Province, China
| | - Wenqing Qu
- Department of Orthopaedics, Yantaishan Hospital, NO.91 Jiefang Road, Zhifu District, Yantai, 264001, Shandong Province, China.
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Pires RE, Giordano V, Boni G, Campos TVO, Lopes MTC, de Andrade MAP. Expanding the indications for calcaneal plates beyond foot fractures: a technical trick and case series. Eur J Orthop Surg Traumatol 2020; 31:275-282. [PMID: 32809148 DOI: 10.1007/s00590-020-02757-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 08/01/2020] [Indexed: 11/30/2022]
Abstract
Although non-locking calcaneal plates are designed to treat calcaneal fractures, they present some interesting characteristics that justify using them beyond their current application in fractures of the foot. Calcaneal plates are malleable, have an increased footprint area for fracture containment or buttressing, and present several hole options for screw placement in different trajectories, thereby providing proper fixation even in comminuted fracture patterns. The aim of this study is to describe the unconventional use of calcaneal plates in the orthopaedic trauma scenario.
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Affiliation(s)
- Robinson E Pires
- Departamento do Aparelho Locomotor, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Santa Efegênia, Belo Horizonte, MG, Brazil.
| | - Vincenzo Giordano
- Serviço de Ortopedia e Traumatologia Professor Nova Monteiro - Hospital Municipal Miguel Couto, Rio de Janeiro, RJ, Brazil
| | - Guilherme Boni
- Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Tulio Vinicius Oliveira Campos
- Departamento do Aparelho Locomotor, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Santa Efegênia, Belo Horizonte, MG, Brazil.,Serviço de Ortopedia e Traumatologia. Hospital Metropolitano Célio de Castro, Belo Horizonte, MG, Brazil
| | - Marcos Tadeu Caires Lopes
- Serviço de Ortopedia e Traumatologia. Hospital Metropolitano Célio de Castro, Belo Horizonte, MG, Brazil
| | - Marco Antônio Percope de Andrade
- Departamento do Aparelho Locomotor, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Santa Efegênia, Belo Horizonte, MG, Brazil
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Vicenti G, Bizzoca D, Nappi VS, Carrozzo M, Delmedico M, Solarino G, Moretti B. The impact of lag screw in the healing time of distal tibia fractures treated with minimally invasive plate osteosynthesis: A randomized clinical trial. Injury 2020; 51 Suppl 3:S80-S85. [PMID: 32070556 DOI: 10.1016/j.injury.2020.02.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 01/26/2020] [Accepted: 02/09/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND In recent years, Minimally Invasive Plate Osteosynthesis (MIPO) has been gaining popularity in the treatment of distal tibia fractures, because it is a minimally invasive surgical procedure, thus it limits the soft-tissues damage. This prospective randomized study aims to assess the impact of lag screw in the healing time of distal tibia fractures treated with MIPO technique, in a six-month follow-up. METHODS Patients between 20 and 70 years of age with distal tibial fracture, type 43-A according to AO/OTA classification system were included. All the patients were randomized into two groups, to receive MIPO without lag screw (Group-A) or MIPO with percutaneous lag screw (Group-B). Patients were followed clinically and radiographically at 3, 6, 12 and 24 weeks postoperatively. The main outcome measure was the time needed to achieve the painless full weight-bearing (FWB) after surgery. Unpaired t-test after ANOVA (analysis of variance) was performed to assess AOFAS score differences between the 2 groups at each follow-up. Pearson correlation test also was performed. The tests were two-tailed with a confidence level of 5%. RESULTS 42 patients (24 male and 18 female, mean age 49.54 years old, range 25-80) were recruited. A significant shorter mean time until painless FWB (p = 0.016) was observed in Group-B (11.22 ± 3.06 weeks) compared with Group-A (13.48 ± 2.42 weeks) (Table 2). The mean AOFAS score was comparable in patients treated with (Group-B) and without lag screw (Group-A) at all follow-ups. CONCLUSIONS This prospective randomized clinical study has shown that the use of lag screw in distal tibia fractures treated with MIPO technique speeds the fracture healing, thus shortening the time needed to achieve FWB.
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Affiliation(s)
- Giovanni Vicenti
- Orthopedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100 Bari, Italy
| | - Davide Bizzoca
- Orthopedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100 Bari, Italy
| | - Vittorio Saverio Nappi
- Orthopedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100 Bari, Italy
| | - Massimiliano Carrozzo
- Orthopedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100 Bari, Italy.
| | - Michelangelo Delmedico
- Orthopedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100 Bari, Italy
| | - Giuseppe Solarino
- Orthopedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100 Bari, Italy
| | - Biagio Moretti
- Orthopedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100 Bari, Italy
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Prasad PNVSV, Nemade A, Anjum R, Joshi N. Extra-articular distal tibial fractures, is interlocking nailing an option? A prospective study of 147 cases. Chin J Traumatol 2019; 22:103-107. [PMID: 30879966 PMCID: PMC6488517 DOI: 10.1016/j.cjtee.2018.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 10/30/2018] [Accepted: 11/15/2018] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Distal tibia fractures comprise about 7%-10% of lower extremity trauma. Because of the peculiarity of the soft tissue and subcutaneous location of the bone there are many controversies in the ideal treatment of distal tibia fractures especially extra articular pilon fractures. Plating is fraught with complications of wound dehiscence and infection. There are limited studies which document outcomes in such cases using intramedullary interlocking nail. We intend to study the outcome and complications of extra articular distal tibial fractures treated with interlocking nailing. METHODS This is a prospective study conducted in a tertiary care orthopaedic hospital in southern India. There are 147 patients of distal tibia extra-articular fractures managed by IM nailing with follow up of more than one year were included in this study. Only cases with fresh injury (less than 1 week), fracture below the isthmus, closed and open Gustilo Anderson type 1 and 2 fractures were included in the study. Patients were reviewed at 3, 6, 12 and 24 weeks after surgery and thereafter at one year and were assessed for clinical and radiological signs of healing, any complications, time to union and functional outcome. RESULTS There were 102 males and 45 females (male/female ratio is 2.3:1) with a mean age of 38.96 (range 23-65) years. According to AO classification, there were 78 cases (53.06%) of 43-A1, 39 cases (26.53%) of 43-A2 and 30 cases of 43-A3 constituting 20.40%. The fracture united in all the patients at an average of 18 weeks (range 16-22 weeks), none of the patient in our series had a delayed or non-union. Two patients (1.47%) had the fracture united in mild valgus but it was well within the acceptable limits (<5°). The functional outcome was assessed in all the patients at final follow up using Olerud and Molander score all the patients fared an excellent to good score, there were no cases with poor score. CONCLUSION Intramedullary nailing is a viable option to treat distal tibial fractures with excellent outcome. Wound complications related to plating can be avoided but meticulous surgical technique is key to avoid malunion.
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Affiliation(s)
- PNVSV Prasad
- Department of Orthopaedics, Srujan Ortho and Accident Care Hospital, Khammam, AP, India
| | - Amit Nemade
- Department of Orthopaedics, Children Orthopaedic Centre, Mumbai, India
| | - Rashid Anjum
- Department of Orthopaedics, MM Institute of Medical Sciences and Research, Ambala, India,Corresponding author.
| | - Nilesh Joshi
- Department of Orthopaedics, N K P Salve Institute of Medical Sciences, Nagpur, India
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Bai J, Wang Y, Zhang P, Liu M, Wang P, Wang J, Liang Y. Efficacy and safety of 3D print-assisted surgery for the treatment of pilon fractures: a meta-analysis of randomized controlled trials. J Orthop Surg Res 2018; 13:283. [PMID: 30419933 PMCID: PMC6233356 DOI: 10.1186/s13018-018-0976-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 10/17/2018] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To compare the effects of 3D print-assisted surgery and conventional surgery in the treatment of pilon fractures. METHODS PubMed, Embase, Web of Science, CNKI, CBM, and WanFang data were searched until July 2018. Two reviewers selected relevant studies, assessed the quality of studies, and extracted data. For continuous data, a weighted mean difference (WMD) and 95% confidence intervals (CI) were used. For dichotomous data, a relative risk (RR) and 95% CI were calculated as the summary statistics. RESULTS There were seven randomized controlled trials (RCT) enrolling a total of 486 patients, 242 patients underwent 3D print-assisted surgery and 244 patients underwent conventional surgery. The pooled outcomes demonstrate 3D print-assisted surgery was superior to conventional surgery in terms of operation time [WMD = - 26.16, 95% CI (- 33.19, - 19.14), P < 0.001], blood loss [WMD = - 63.91, 95% CI (- 79.55, - 48.27), P < 0.001], postoperative functional scores [WMD = 8.16, 95% CI (5.04, 11.29), P < 0.001], postoperative visual analogue score (VAS) [WMD = - 0.59, 95% CI (- 1.18, - 0.01), P = 0.05], rate of excellent and good outcome [RR = 1.20, 95% CI (1.07, 1.34), P = 0.002], and rate of anatomic reduction [RR = 1.35, 95% CI (1.19, 1.53), P < 0.001]. However, there was no significant difference between the groups regarding the rate of infection [RR = 0.51, 95% CI (0.20, 1.31), P = 0.16], fracture union time [WMD = - 0.85, 95% CI (- 1.79, 0.08), P = 0.07], traumatic arthritis [RR = 0.34, 95% CI (0.06, 2.09), P = 0.24], and malunion [RR = 0.34, 95% CI (0.06, 2.05), P = 0.24]. CONCLUSIONS Our meta-analysis demonstrates 3D print-assisted surgery was significantly better than conventional surgery in terms of operation time, blood loss, postoperative functional score, postoperative VAS, rate of excellent and good outcome, and rate of anatomic reduction. Concerning postoperative complications, there were no significant differences between the groups.
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Affiliation(s)
- Jianzhong Bai
- Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Yongxiang Wang
- Clinical Medical College, Yangzhou University, Yangzhou, 225001, China
| | - Pei Zhang
- Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Meiying Liu
- Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Peian Wang
- Heze Mudan People's Hospital, Heze, 274000, China
| | - Jingcheng Wang
- Clinical Medical College, Yangzhou University, Yangzhou, 225001, China.
| | - Yuan Liang
- Clinical Medical College, Yangzhou University, Yangzhou, 225001, China.
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Abstract
Actually, pilon fractures are classified according to AO and Ruedi Allgower classification systems based on X-rays. These classifications are less reproducible and do not provide necessary information for proper surgical planning. Aim of the study is to (1) propose a new classification system based on CT scan; (2) to check the prognostic value of this classification and (3) to evaluate its reliability and (4) reproducibility. We retrospectively reviewed 71 cases of pilon fracture. All fractures were classified according to AO, Ruedi Allgower and new proposed classification system by 5 surgeons. Clinical and radiographic evaluation were performed at a mean follow-up of 36 months. Cohen's K value was calculated in order to evaluate the interobserver and intraobserver agreement. Sixty-four of 71 fractures healed. Average AOFAS score was 91,7±7,8 in the Type I of new classification proposed, 87,7±7,8 in the Type II, 82±18,6 in type III, and 67,2±20,9 in type IV. Using the AO classification system the average K weighted value among the five reviewers was 0,51; using Ruedi Allgower classification it was 0,50 and using the new classification system it was 0,88 (p<0.0005). This study demonstrated that the new classification system is prognostic, reliable and reproducible. Moreover it provides a new treatment-oriented classification for this challenging fracture which affect the quality of life of the patients more than chronic diseases like diabetes and coronaropathy or pelvic fractures.
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18
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Zhang SB, Zhang YB, Wang SH, Zhang H, Liu P, Zhang W, Ma JL, Wang J. Clinical efficacy and safety of limited internal fixation combined with external fixation for Pilon fracture: A systematic review and meta-analysis. Chin J Traumatol 2017; 20:94-98. [PMID: 28359592 PMCID: PMC5392718 DOI: 10.1016/j.cjtee.2016.06.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 07/08/2016] [Accepted: 07/21/2016] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To compare the clinical efficacy and complications of limited internal fixation combined with external fixation (LIFEF) and open reduction and internal fixation (ORIF) in the treatment of Pilon fracture. METHODS We searched databases including Pubmed, Embase, Web of science, Cochrane Library and China Biology Medicine disc for the studies comparing clinical efficacy and complications of LIFEF and ORIF in the treatment of Pilon fracture. The clinical efficacy was evaluated by the rate of nonunion, malunion/delayed union and the excellent/good rate assessed by Mazur ankle score. The complications including infections and arthritis symptoms after surgery were also investigated. RESULTS Nine trials including 498 pilon fractures of 494 patients were identified. The meta-analysis found no significant differences in nonunion rate (RR = 1.60, 95% CI: 0.66 to 3.86, p = 0.30), and the excellent/good rate (RR = 0.95, 95% CI: 0.86 to 1.04, p = 0.28) between LIFEF group and ORIF group. For assessment of infections, there were significant differences in the rate of deep infection (RR = 2.18, 95% CI: 1.34 to 3.55, p = 0.002), and the rate of arthritis (RR = 1.26, 95% CI: 1.03 to 1.53, p = 0.02) between LIFEF group and ORIF group. CONCLUSION LIFEF has similar effect as ORIF in the treatment of pilon fractures, however, LIFEF group has significantly higher risk of complications than ORIF group does. So LIFEF is not recommended in the treatment of pilon fracture.
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Shen XF, Mi JY, Rui YJ, Xue MY, Chou J, Tian J, Chim H. Delayed treatment of unstable proximal interphalangeal joint fracture-dislocations with a dynamic external fixator. Injury 2015; 46:1938-44. [PMID: 26144906 DOI: 10.1016/j.injury.2015.06.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 06/09/2015] [Accepted: 06/10/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Fracture-dislocations of the proximal interphalangeal joint (PIPJ) remain a challenging problem to treat. Although there are a number of papers describing the use of dynamic external fixators and force couples for treatment of unstable PIPJ fracture-dislocations acutely, the literature is scarce on delayed treatment of PIPJ fracture-dislocations, where malunion of the articular surface may theoretically compromise postoperative range of motion (ROM) at the PIPJ. The purpose of this study was to evaluate the effectiveness of dynamic distraction external fixation (DDEF) for the delayed treatment of PIPJ fracture-dislocations at least 3 weeks after the inciting injury. METHODS Ten consecutive patients were treated with delayed DDEF between 2010 and 2013. Postoperative ROM at the PIPJ was measured. Disabilities of the Arm, Shoulder and Hand (DASH) score and Michigan Hand Outcomes Questionnaire were administered to all patients postoperatively. RESULTS Mean time from injury to surgery was 27.5 days. The mean follow-up period was 23.7 months (range 10-36). The mean active ROM at the PIPJ on final postoperative follow-up was 83.9° (range 52-100). None of the patients experienced pin-tract infections. Mean DASH score was 3.7+3.4 and mean Michigan Hand Outcomes Questionnaire score was 97.3+3.0. All patients returned to work and resumed normal activities. CONCLUSIONS Delayed treatment of unstable PIPJ fracture-dislocations with a DDEF is effective in restoring function to the PIPJ. Nascent malunion of the PIPJ articular surface does not compromise postoperative outcomes and the joint surface undergoes remodelling over time to restore a smooth and functional articular surface.
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Affiliation(s)
- Xiao Fang Shen
- Department of Hand Surgery, Wuxi 9th People's Hospital, Wuxi, Jiangsu, China
| | - Jing Yi Mi
- Department of Hand Surgery, Wuxi 9th People's Hospital, Wuxi, Jiangsu, China
| | - Yong Jun Rui
- Department of Hand Surgery, Wuxi 9th People's Hospital, Wuxi, Jiangsu, China.
| | - Ming Yu Xue
- Department of Hand Surgery, Wuxi 9th People's Hospital, Wuxi, Jiangsu, China
| | - Jiandong Chou
- Department of Hand Surgery, Wuxi 9th People's Hospital, Wuxi, Jiangsu, China
| | - Jian Tian
- Department of Hand Surgery, Wuxi 9th People's Hospital, Wuxi, Jiangsu, China
| | - Harvey Chim
- Division of Plastic Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
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Jacob N, Amin A, Giotakis N, Narayan B, Nayagam S, Trompeter AJ. Management of high-energy tibial pilon fractures. Strategies Trauma Limb Reconstr 2015; 10:137-47. [PMID: 26407690 PMCID: PMC4666229 DOI: 10.1007/s11751-015-0231-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 08/23/2015] [Indexed: 11/26/2022] Open
Abstract
Tibial pilon fractures result from high-energy trauma unlike usual ankle fractures. Their management provides numerous challenges to the orthopaedic surgeon including obtaining anatomic reduction of articular surface and the management of associated soft tissue injuries. This article aims to review major advances and principles that guide our practice today. We also discuss a treatment algorithm based on a staged approach to the fracture: initial spanning external fixation followed by definitive fixation.
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Affiliation(s)
- Nebu Jacob
- Department of Trauma and Orthopaedic Surgery, St Georges Healthcare NHS Trust, Blackshaw Road, Tooting, London, SW17 0QT, UK.
- , 1 Locke Gardens, Slough, Berkshire, SL3 7BE, UK.
| | - Amit Amin
- Department of Trauma and Orthopaedic Surgery, St Georges Healthcare NHS Trust, Blackshaw Road, Tooting, London, SW17 0QT, UK
| | - Nikolaos Giotakis
- Limb Reconstruction Unit, Department of Trauma and Orthopaedic Surgery, Royal Liverpool and Broadgreen University Hospital NHS Trust, Liverpool, L7 8XP, UK
| | - Badri Narayan
- Limb Reconstruction Unit, Department of Trauma and Orthopaedic Surgery, Royal Liverpool and Broadgreen University Hospital NHS Trust, Liverpool, L7 8XP, UK
| | - Selvadurai Nayagam
- Limb Reconstruction Unit, Department of Trauma and Orthopaedic Surgery, Royal Liverpool and Broadgreen University Hospital NHS Trust, Liverpool, L7 8XP, UK
| | - Alex J Trompeter
- Department of Trauma and Orthopaedic Surgery, St Georges Healthcare NHS Trust, Blackshaw Road, Tooting, London, SW17 0QT, UK
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Abstract
Intra-articular fractures of the tibial plafond are typically the result of rotational or axial loading forces, and both mechanisms of injuries can result in an associated fibula fracture. Rotational distal tibial plafond fractures are typically of lower energy and are associated with less articular injury and chondral impaction, whereas axial load injuries of the distal tibial plafond are associated with a higher incidence of intra-articular and soft tissue injury. The goal of this article is to review the mechanisms of injury, fracture patterns, and potential complications associated with the most common presentations of tibial plafond fractures.
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Affiliation(s)
- John J Stapleton
- Foot and Ankle Surgery, VSAS Orthopaedics, Lehigh Valley Hospital, 1250 South Cedar Crest Boulevard, Suite # 110, Allentown, PA 18103, USA; Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, USA.
| | - Thomas Zgonis
- Reconstructive Foot and Ankle Surgery, Division of Podiatric Medicine and Surgery, Department of Orthopaedic Surgery, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive MSC 7776, San Antonio, TX 78229, USA
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Ramlee MH, Kadir MRA, Murali MR, Kamarul T. Finite element analysis of three commonly used external fixation devices for treating Type III pilon fractures. Med Eng Phys 2014; 36:1322-30. [PMID: 25127377 DOI: 10.1016/j.medengphy.2014.05.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 05/19/2014] [Accepted: 05/24/2014] [Indexed: 11/15/2022]
Abstract
Pilon fractures are commonly caused by high energy trauma and can result in long-term immobilization of patients. The use of an external fixator i.e. the (1) Delta, (2) Mitkovic or (3) Unilateral frame for treating type III pilon fractures is generally recommended by many experts owing to the stability provided by these constructs. This allows this type of fracture to heal quickly whilst permitting early mobilization. However, the stability of one fixator over the other has not been previously demonstrated. This study was conducted to determine the biomechanical stability of these external fixators in type III pilon fractures using finite element modelling. Three-dimensional models of the tibia, fibula, talus, calcaneus, navicular, cuboid, three cuneiforms and five metatarsal bones were reconstructed from previously obtained CT datasets. Bones were assigned with isotropic material properties, while the cartilage was assigned as hyperelastic springs with Mooney-Rivlin properties. Axial loads of 350 N and 70 N were applied at the tibia to simulate the stance and the swing phase of a gait cycle. To prevent rigid body motion, the calcaneus and metatarsals were fixed distally in all degrees of freedom. The results indicate that the model with the Delta frame produced the lowest relative micromovement (0.03 mm) compared to the Mitkovic (0.05 mm) and Unilateral (0.42 mm) fixators during the stance phase. The highest stress concentrations were found at the pin of the Unilateral external fixator (509.2 MPa) compared to the Mitkovic (286.0 MPa) and the Delta (266.7 MPa) frames. In conclusion, the Delta external fixator was found to be the most stable external fixator for treating type III pilon fractures.
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Affiliation(s)
- Muhammad Hanif Ramlee
- Medical Devices and Technology Group (MEDITEG), Faculty of Biosciences and Medical Engineering, Universiti Teknologi Malaysia, 81310 Johor Bahru, Johor, Malaysia.
| | - Mohammed Rafiq Abdul Kadir
- Medical Devices and Technology Group (MEDITEG), Faculty of Biosciences and Medical Engineering, Universiti Teknologi Malaysia, 81310 Johor Bahru, Johor, Malaysia.
| | - Malliga Raman Murali
- Tissue Engineering Group (TEG), National Orthopaedic Centre of Excellence in Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty ofMedicine, University of Malaya, 50603 Lembah Pantai, Kuala Lumpur, Malaysia.
| | - Tunku Kamarul
- Tissue Engineering Group (TEG), National Orthopaedic Centre of Excellence in Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty ofMedicine, University of Malaya, 50603 Lembah Pantai, Kuala Lumpur, Malaysia.
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Korkmaz A, Ciftdemir M, Ozcan M, Copuroğlu C, Sarıdoğan K. The analysis of the variables, affecting outcome in surgically treated tibia pilon fractured patients. Injury 2013; 44:1270-4. [PMID: 23871428 DOI: 10.1016/j.injury.2013.06.016] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 05/23/2013] [Accepted: 06/17/2013] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Treatment of tibia pilon fractures is challenging. Outcome after tibia pilon fractures depend on multiple factors. Aim of this study is to evaluate the potential variables that are known to affect the outcome after tibia pilon fractures. PATIENTS AND METHODS Forty patients with 42 tibia pilon fractures with a one-year follow-up, who had undergone surgical treatment between January 2007 and June 2011, were evaluated, retrospectively. Patients were divided into 3 groups regarding the choice of surgical treatment (Group A-22 patients treated with open reduction-internal fixation; Group B-9 patients treated with mini-open reduction-internal fixation and external fixation; and Group C-11 patients treated with closed reduction-external fixation). Fractures were classified using Müller-AO and Rüedi/Allgöwer classifications. Quality of reduction was evaluated using Ovadia and Beals' criteria. All patients underwent functional assessment using AOFAS ankle-hindfoot scale and Teeny-Wiss scoring system at the last follow-up. RESULTS Mean age of the patients was 49 (20-80). There were eight 43-B3, six 43-C1, twelve 43-C2 and sixteen 43-C3 fractures according to Müller-AO classification and ten type 1, ten type 2 and twenty two type 3 fractures according to Rüedi/Allgöwer classification. There were 15 (35.7%) open fractures. No statistically significant relation was found between quality of reduction and type of surgery. Also no significant relation was found between the type of surgery and functional scores. No significant correlation was found between functional scores and Müller-AO classification, but functional scores were found significantly worse in Rüedi/Allgöwer type 3 fractures. Functional scores were found significantly related to the quality of reduction. Early complications were seen in 22 and late complications were seen in 9 fractures. No statistically significant relation was found between complications, type of surgery and functional scores. CONCLUSION The most important factor affecting outcome in surgically treated tibia pilon fractures was quality of reduction. Poor functional scores were found independent from the type of surgery and quality of reduction in Rüedi/Allgöwer type 3 fractures, which was characterized with articular surface comminution and metaphyseal impaction.
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Affiliation(s)
- Aytel Korkmaz
- Department of Orthopaedic Surgery, Trakya University School of Medicine, Balkan Yerleskesi, 22030 Edirne, Turkey
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