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TIBIAL PILON FRACTURES IN ADULTS: OUR EXPERIENCE AND TREATMENT ALGORITHMThe tibial pilon fractures constitute about 5-7% of fractures of the tibia. The treatment of this type of fracture is a very timely topic, since there is no real consensus on the unique methods of treatment, which must take into account not only the stabilization of bone but also soft tissue which frequently leads to complications. at the Torino Nord Emergenza San Giovanni Bosco hospital were treated 16 patients (7 men, 9 women, mean age 49 ± 18.9 years) with tibial pilon fracture with emergency stabilization with external fixator and subsequent treatment following a biphasic protocol. The most frequently used treatment was external fixation (62.5%), alone (4 cases) or associated with a summary percutaneous screws (6 cases), while ORIF was selected as definitive treatment in 37.5% of cases. The authors present their experience in the surgical treatment of such fractures with special attention to the most recent international guidelines, the decision algorithms and the timing of surgery. Currently was not prooved in any way the superiority of any specific treatment method, the only recommendation to use a two-phase protocol for the treatment of soft tissue. This again brings out the complexity of the treatment of tibial pilon fractures and the importance of further studies (including randomized controlled trials) for the formulation of evidence-based treatment recommendations. In clinical practice, in is crucial a careful and detailed patient explanation to the patient of the risks of this type of surgery and risks of evolution in ankle osteoarthritis. Aggiornamenti IntroduzioneIl pilone tibiale corrisponde anatomicamente all'estremità inferiore della tibia, cioè all'epifisi distale, compresa la superficie articolare. Il suo limite superiore è rappresentato all'incirca a 8-10 cm dalla superficie articolare tibio-tarsica, dove la sezione triangolare della diafisi tibiale, con una cresta anteriore, cambia di direzione. La particolare conformazione tridimensionale di questa zona scheletrica permette di aumentare la superficie di carico, distribuendola sull'articolazione tibio-tarsica e quella malleolare [1]. Le fratture del pilone tibiale costituiscono circa il 5-7% delle fratture della tibia [2]. Il trattamento di questo tipo di fratture costituisce un argomento di grande attualità [3,4], in quanto non esiste un vero e proprio consenso univoco sulle metodiche di trattamento, che deve tenere in considerazione non solo la stabilizzazione ossea, ma anche quella dei tessuti molli che costituisce frequente causa di complicanze [5,6]. Inoltre, per evitare l'evoluzione
TIBIAL PILON FRACTURES IN ADULTS: OUR EXPERIENCE AND TREATMENT ALGORITHMThe tibial pilon fractures constitute about 5-7% of fractures of the tibia. The treatment of this type of fracture is a very timely topic, since there is no real consensus on the unique methods of treatment, which must take into account not only the stabilization of bone but also soft tissue which frequently leads to complications. at the Torino Nord Emergenza San Giovanni Bosco hospital were treated 16 patients (7 men, 9 women, mean age 49 ± 18.9 years) with tibial pilon fracture with emergency stabilization with external fixator and subsequent treatment following a biphasic protocol. The most frequently used treatment was external fixation (62.5%), alone (4 cases) or associated with a summary percutaneous screws (6 cases), while ORIF was selected as definitive treatment in 37.5% of cases. The authors present their experience in the surgical treatment of such fractures with special attention to the most recent international guidelines, the decision algorithms and the timing of surgery. Currently was not prooved in any way the superiority of any specific treatment method, the only recommendation to use a two-phase protocol for the treatment of soft tissue. This again brings out the complexity of the treatment of tibial pilon fractures and the importance of further studies (including randomized controlled trials) for the formulation of evidence-based treatment recommendations. In clinical practice, in is crucial a careful and detailed patient explanation to the patient of the risks of this type of surgery and risks of evolution in ankle osteoarthritis. Aggiornamenti IntroduzioneIl pilone tibiale corrisponde anatomicamente all'estremità inferiore della tibia, cioè all'epifisi distale, compresa la superficie articolare. Il suo limite superiore è rappresentato all'incirca a 8-10 cm dalla superficie articolare tibio-tarsica, dove la sezione triangolare della diafisi tibiale, con una cresta anteriore, cambia di direzione. La particolare conformazione tridimensionale di questa zona scheletrica permette di aumentare la superficie di carico, distribuendola sull'articolazione tibio-tarsica e quella malleolare [1]. Le fratture del pilone tibiale costituiscono circa il 5-7% delle fratture della tibia [2]. Il trattamento di questo tipo di fratture costituisce un argomento di grande attualità [3,4], in quanto non esiste un vero e proprio consenso univoco sulle metodiche di trattamento, che deve tenere in considerazione non solo la stabilizzazione ossea, ma anche quella dei tessuti molli che costituisce frequente causa di complicanze [5,6]. Inoltre, per evitare l'evoluzione
Background:Tibial platfond fractures are usually associated with massive swelling of the foot and ankle, as well as with open wounds. This swelling may cause significant decrease of the blood flow, so the state of the soft tissue is determinant for the surgical indication and the type of implant. This retrospective study compares the union times in cases of tibial plafond fractures managed with a hybrid external fixation as a definitive procedure versus those managed with a two stage strategy with final plate fixation.Materials and Methods:A retrospective study in a polytrauma referral hospital was performed between 2005 and 2011. Patients with a tibial plafond fracture, managed with a hybrid external fixation as a definitive procedure or managed with a two stage strategy with the final plate fixation were included in the study. Postoperative radiographs were evaluated by two senior surgeons. Fracture healing was defined as callus bridging of one cortex, seen on both lateral and anteroposterior X-ray. The clinical outcome was evaluated by means of 11 points Numerical Rating Scale for pain and The American Orthopedic Foot and Ankle Society ankle score, assessed at the last followup visit. Thirteen patients had been managed with a hybrid external fixation and 18 with a two-stage strategy with the final plate fixation. There were 14 males and 17 females with a mean age of 48 years (range 19–82 years). The mean followup was 24 months (range 24–70 months).Results:The mean time from surgery to weight bearing was 7 ± 6.36 days for the hybrid fixation group and 57.43 ± 15.46 days for the plate fixation group (P < 0.0001); and the mean time from fracture to radiological union was 133.82 ± 37.83) and 152.8 ± 72.33 days respectively (P = 0.560).Conclusion:Besides the differences between groups regarding the baseline characteristics of patients, the results of this study suggest that in cases of tibial plafond fractures, the management with a hybrid external fixation as a definitive procedure might involve a faster union than a two-stage management with final plate fixation.
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