High-energy tibial pilon fractures: an instructional review

Zelle, Boris A.; Dang, Khang H.; Ornell, Samuel S.

doi:10.1007/s00264-019-04344-8

Cited by 64 publications

(78 citation statements)

References 59 publications

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“…Pilon fractures are comminuted distal tibial fractures involving the ankle joint surface with bone loss and cancellous bone compression; they are often combined with severe soft tissue damage [1]. This fracture type has a high rate of complications, such as infection nonunion, malunion and post-traumatic arthritis.…”

Section: Introductionmentioning

confidence: 99%

Novel anterior curved incision combined with MIPO for Pilon fracture treatment

Peng

Ren

et al. 2020

BMC Musculoskelet Disord

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Backgrounds: Poor prognosis was reported for complex Pilon fractures involving severe soft tissue damage. It is therefore useful to explore the evolution of different treatment strategies in an effort to reconstruct the axial alignment and articular surface, while minimizing additional damage to the surrounding soft tissues. Methods: Seventeen patients with Pilon fractures were enrolled in this retrospective study from December 2009 to October 2014. The injuries were graded according to AO Classification and the Gustilo-Anderson system. Patients were treated with minimally invasive plate osteosynthesis (MIPO) combined with curved incision on the anterior area of ankle. The ankle function and radiological outcome were assessed by the modified Mazur ankle score and Burwell-Charnley criteria, respectively. Visual analogue score (VAS) score was used to assess the degree of patient's ankle pain, and related complications were also recorded. Results: The mean time for fracture healing was 3.6 months (range: 3-6 months). According to Mazur's criteria, surgical treatment achieved good or excellent outcome in 15 (88.2%) cases, and the average VAS score was 1.19 ± 0.52. On the basis of Burwell-Charnley score, 12 (70.5%) patients achieved anatomic recovery, 4 (23.5%) obtained good reduction, and only 1 (5.9%) patient was diagnosed with valgus deformity. Additionally, 1 (5.9%) patient developed a superficial infection around incision, and 2 (11.8%) experienced superficial peroneal nerve damage. In addition, 2 (11.8%) patients showed radiographic evidence of existing ankle osteoarthritis at the final follow-up. Conclusions: This retrospective study is the first to assess the application of a curved incision on the anterior area of ankle with MIPO for the treatment of Pilon fractures, which achieves high functional recovery with a low complication rate. However, large randomized controlled trials comparing different approaches and fixation methods are still needed to conclusively identify the optimal treatment protocol.

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Section: Introductionmentioning

confidence: 99%

Novel anterior curved incision combined with MIPO for Pilon fracture treatment

Peng

Ren

et al. 2020

BMC Musculoskelet Disord

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“…Therefore, two-staged management, consisting of initial fracture stabilization followed by internal xation, were performed for these high-energy tibial fractures. In a study on the staged treatment of pilon fractures, Zelle et al [7] reported that severe soft tissue injuries usually require a transitional stage of 1-4 weeks. Canton et al [8] reported that internal xation can be attempted doe tibial plateau fractures combined with soft tissue injuries 2-13 days after the injury.…”

Section: Discussionmentioning

confidence: 99%

Early complications of preoperative external traction fixation in staged treatment of tibial fractures: a 402 cases series study

Yang¹,

Zhu

Dong³

2020

Preprint

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Background and Objective: Different external skeletal fixators have been widely used in preoperative traction of high-energy tibial fractures prior to a definitive surgical treatment. However, early complications associated with this staged treatment for traction and soft tissue injury recovery have rarely been discussed. This study aimed to analyze the early complications associated with preoperative external traction fixation in the staged treatment of tibial fractures.Materials and Methods: A total of 402 patients with high-energy tibial fractures treated using preoperative external traction fixation at a level-1 trauma center from 2014 to 2018 were enrolled in this retrospective study. Data regarding the demographic information, Tscherne soft tissue injury, fracture site, entry point placement, and duration of traction were recorded. Procedure-related complications such as movement and sensation disorder, vessel injury, discharge, infection, loosening, and iatrogenic fracture were analyzed.Results: The mean patient age was 42.5 (18–71) years and the mean duration of traction was 7.5 (0–26) days. In total, 19 (4.7%) patients presented with procedure-related complications, including technique-associated complications in 6 patients and nursing-associated complications in 13. Differences in the incidence of complications with respect to sex, affected side, soft tissue injury classification, and fracture sites were not observed. However, the number of complications due to hammer insertions was significantly fewer than those due to drill insertions (2.9% vs. 7.4%).Conclusion: The application of preoperative external traction fixation had been proved to be an ideal alternative treatment for high energy tibial fractures. In this study, we found the incidence of early complications of the fixation is low, and it is not significantly associated with the severity of soft tissue injury and fracture site. Although relatively rough and more likely to cause pain, complications of hammer insertions were significantly fewer than drill insertions. The possible reason was higher probability of heat damage and loosening by drilling.

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“…Donati vertical mattress sutures were used to close the wound. [3] Post-operative radiographs were taken on the next day of surgery and at the latest follow-up ( Figure 2C, D).…”

Section: Surgical Techniquementioning

confidence: 99%

Large Autologous Ilium with Periosteum for Tibiotalar Joint Reconstruction in Rüedi-Allgöwer III Pilon Fractures

Liu

Zhu

et al. 2020

Preprint

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Background: Management of Rüedi-Allgöwer III or AO type C3 pilon fracture present numerous challenges to the orthopaedic surgeon. A joint preservation technique using a large autologous ilium with periosteum in combination with internal implant fixation was reported to improve the outcome of reconstruction. Methods: Twenty-five patients with soft tissue injury of Tscherne-Gotzen I-II after Rüedi-Allgöwer III pilon fracture received a large autologous ilium with periosteum for tibiotalar joint reconstruction and open reduction and internal fixation (ORIF), between March 2015 and September 2018. The visual analog scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) score, and Burwell and Charnley criteria were used for outcome analysis.Results: Twenty patients with an average age of 45.2 years were followed for an average of 18.3 months. The VAS and AOFAS scores, and Burwell and Charnley ratings were recorded at the last follow-up after reconstructive surgery. Two patients developed redness and swelling at the wound site, but recovered after local care and dressing changes. No patient displayed deep surgical site infection, donor site complication, non-union or local complication during the final follow-up. The average bone union time was 18.3 months (range 3-36).Conclusions: Large autologous ilium with periosteum in combination with ORIF can be safely performed for tibiotalar joint reconstruction. This method greatly reduces the risk of post-operative complications following articular reconstruction for Rüedi-Allgöwer III pilon fractures.Level of Evidence: Level III, retrospective cohort study

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High-energy tibial pilon fractures: an instructional review

Cited by 64 publications

References 59 publications

Novel anterior curved incision combined with MIPO for Pilon fracture treatment

Novel anterior curved incision combined with MIPO for Pilon fracture treatment

Early complications of preoperative external traction fixation in staged treatment of tibial fractures: a 402 cases series study

Large Autologous Ilium with Periosteum for Tibiotalar Joint Reconstruction in Rüedi-Allgöwer III Pilon Fractures

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