Does a Staged Posterior Approach Have a Negative Effect on OTA 43C Fracture Outcomes?

Chan, Daniel Shiu‐Hin; Balthrop, Paul M.; White, Brian; Glassman, David M.; Sanders, Roy

doi:10.1097/bot.0000000000000728

Cited by 26 publications

(17 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…After a minimum 1-year follow-up, the articular reduction and ankle function score improved in the staged posterior tibial plating group much better than in the direct anterior tibial plating group. However, after prolonged clinical study, Chan et al reported that addition of the staged posterior approach did not benefit the articular reduction but significantly increased the risk of nonunion [4]. Consequently, the best way to balance the articular reduction with the multiple complications of fracture healing and ankle function should be further explored.…”

Section: Discussionmentioning

confidence: 99%

“…Combined approaches provide sufficient articular visualization, facilitating both reduction and fixation. However, one study reported that the combined approaches possibly increased the risk of fracture healing and soft tissue complications [4]. The reason may be that the combined approach increases surgical stripping and damage to the blood supply of bone tissue.…”

Section: Discussionmentioning

confidence: 99%

“…These complications have led many surgeons to choose external fixation as primary stage surgery. After the soft tissue swelling subsidies, definitive internal fixation can then be performed [4].…”

Section: Introductionmentioning

confidence: 99%

“…To better restore the articular surface, different fixation methods have been advocated. There is still some confusion in the literature as to the best treatment strategy for AO classification-type C3 pilon fractures [4–6]. Ketz reported that the addition of a posterolateral approach ensured accurate reduction of the tibiotalar joint [5].…”

Section: Introductionmentioning

confidence: 99%

“…Chan et al reported that there was no statistically proven benefit to combined surgical approaches to treat tibial pilon fractures with regard to the quality of articular reduction. However, the addition of the staged posterior approach significantly increased the risk of nonunion [4].…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Treatment of AO/OTA 43-C3 Pilon Fracture: Be Aware of Posterior Column Malreduction

Guan

Huang

Wang

et al. 2019

BioMed Research International

View full text Add to dashboard Cite

Treatment of pilon fractures remains challenging due to the difficulty of fracture reduction and associated soft tissue complications. The aim of this study was to evaluate the pitfalls and strategies of posterior column reduction in the treatment of complex tibial pilon fractures (AO/OTA 43-C3). Thirteen AO/OTA classification 43-C3 type pilon fractures treated between January 2013 and January 2016 were retrospectively analyzed. Nine cases were treated by external fixation within 26 hours (range, 6–56 hours) after injury. The definitive open reduction and internal fixation (ORIF) was performed after the wound was healed without infection and soft tissue swelling had subsided. During the delayed/second-stage operation, the articular surface of the distal tibial plafond was reduced through the posterolateral and anterior approaches. X-ray and CT scans were performed pre- or postoperatively. The reduction quality was evaluated using Burwell–Charnley’s radiographic criteria. The follow-up was performed routinely and all complications were recorded. Ankle function was evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score. During the delayed/second-stage operation, primary reduction of the posterior column was performed entirely through posterolateral approaches. However, poor posterior column reduction was revealed by fluoroscopy in four cases, three of which were readjusted through the posterolateral and anterior approaches, and the fourth was adjusted directly through the anterior approach. Postoperative CT scan revealed that the step-off of the articular surface was less than 2 mm in 12 cases, and in only one case the step-off was greater than 2 mm but less than 5 mm. The satisfactory rate was 92.3% according to Burwell–Charnley’s reduction criteria. Eleven patients were followed up regularly; superficial infections occurred in two cases but healed after wound care treatment in 3 and 5 weeks, respectively. All eleven fractures were healed within an average of 3.6 months (range, 2.6–5 months). The average range of ankle motion was 19° of dorsiflexion and 28° of plantar-flexion. The mean AOFAS ankle-hindfoot score was 82 (range, 61–92). In our opinion, we suggest that the reduction of the articular surface should be performed through combined posterolateral and anterior approaches in a delayed operation, with flexible fixation of the posterior column. If the posterior column is poorly reduced, the articular surface can easily be manipulated through anterior approaches. According to this strategy, satisfactory outcomes of AO/OTA C3 pilon fractures would be anticipated.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%