BACKGROUND: Pilon fracture is an intra-articular injury of tibia distal metaepiphysis; its often comminuted. Comprehensive reconstruction of the tibia articular surface and recovery of the axil in the affected extremity is of prime importance for the rehabilitation of patients with such pathology, so priority is given to reconstructive surgical techniques. Pilon injury often causes deforming arthrosis of the ankle joint that reduces its functions. It is ankle arthrodesis that is considered to be the preferred method of surgical rehabilitation in this clinical setting. AIM: The presentation of successful outcomes in patients with consequences of intra-articular fractures of distal tibial metaepiphysis. MATERIALS AND METHODS: Clinical and radiological methods were used to study the initial data and outcomes of 16 patients suffering from pilon fractures. The recovery of the supporting function of the foot and the level of pain syndrome after the treatment were evaluated with the Foot Functional Index questionnaire. Taking into account the obtained clinical and radiological data, all patients underwent bone-plastic arthrodesis of the ankle joint with correction of limb deformity. An intramedullary retrograde tibial lockable rod was used to fix the ankle joint. RESULTS: It was established that the performance of bone-plastic arthrodesis of the ankle joint provides a complete restoration of the supporting function of the injured lower limb with the relief of pain in the period of 34 months after surgery. CONCLUSION: The use of intramedullary retrograde rod with blocking for the fixation of the ankle joint does not require the use of additional immobilization, provides the possibility of early loading on the operated limb.
Aims.The aim of the study was the development and clinical approbation of the method of treatment of purulent arthritis with the formation of ankle ankylosis. Materials and MethodsTwenty-two patients underwent surgery after ankle trauma complicated by inflammation (18 male and 4 females ranging in age from 28 to 62). To open the ankle joint, an anterior approach was used. After opening the cavity of the joint, surgical treatment of the purulent-necrotic focus with necrotic sequestrectomy and resection of the tibia and talus bones were performed within the limits of healthy bone tissue, after which a compression/distraction device was applied. Distraction in the area of the resection of the tibia and talus bones artificially created a cavity in the ankle joint simultaneously. Through additional punctures in the projection of external and internal ankle bones, a perforated drain was placed in the created cavity. [Bonesaw-lines] of the tibia and talus bones were drawn together to the dimensions of the drain tube. In the postoperative period, sanitation of the purulent-necrotic focus was performed by means of continuous draining of the created cavity with antiseptic solutions. After the bacterial inoculation cultures were negative three times, the draining tube was removed, and gradually the tibia and talus bones were moved closer. The external fixation device was switched to the mode of consistent stabilisation with the possibility of putting weight on the damaged extremity. Fixation in the device continued until the X-ray picture of bone ankylosis in the ankle was obtained ResultsFor all patients we were able to achieve stable remission of the inflammation process and formation of a strong bone ankylosis in the ankle. The sanitation period of the purulent-necrotic focus was 14-16 days. After removal of the drain and compression in the external fixation device, the patients were allowed to move on crutches with moderate weight on the operated extremity. Duration of fixation in the device was 16-20 weeks. During 5 years of continuous follow-up, no relapses of inflammation in the ankle joint were observed. Conclusions.The suggested method makes it possible to solve the problem of ending inflammation in the ankle by means of forming bone ankylosis during surgical treatment of purulent osteoarthritis.
We analyzed the treatment outcomes of distal tibia injuries and their consequences in 144 patients with terminal stages of post-traumatic ankle osteoarthritis. The research employed clinical and radiological methods as well as the Foot Function Index questionnaire. Surgical methods involved ankle arthrodesis and various combinations of grafts and fixators. It has been established that osteoplastic arthrodesis during as a part of surgical rehabilitation in patients with the consequences of ankle injuries complicated by the terminal arthrosis ensures a complete restoration of the support function in the injured lower limb as well as pain relief.
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