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Wustro L, Silva JLVD, Moura BAB, Schoenberger HS, Takito D, D'Agostini JCH. Use of Three-dimensional Printing for Tibial Pilon Fracture Diagnosis and Treatment. Rev Bras Ortop 2024; 59:e456-e461. [PMID: 38911898 PMCID: PMC11193579 DOI: 10.1055/s-0044-1785514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/06/2023] [Indexed: 06/25/2024] Open
Abstract
Objective To evaluate whether three-dimensional (3D) printing increases agreement in the classification of tibial pilon fractures. Methods Orthopedists and traumatologists reviewed radiographs, computed tomography scans with 3D reconstruction, and prototyping 3D printing, and classified the fractures based on the Rüedi-Allgöwer and Arbeitsgemeinschaft für Osteosynthesefragen (AO, Association for the Study of Internal Fixation) Foundation/Orthopedic Trauma Association (AO/OTA) classification systems. Next, data evaluation used Kappa agreement coefficients. Results The use of the 3D model did not improve agreement for tibial pilon fractures regarding the treatment proposed by the groups. Regarding the classification systems, the agreement only improved concerning the AO/OTA classification when the 3D model was used in the assessment by the foot and ankle specialists. Conclusion Although 3D printing is statistically relevant for surgeons specializing in foot and ankle, its values remain lower than optimal.
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Affiliation(s)
| | | | | | | | - Debora Takito
- Complexo Hospitalar do Trabalhador, Curitiba, PR, Brasil
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2
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Gao X, Liu F, Wang G, Gao Y, Suyalatu X. Serum caspase‑1 levels serve as a predictive biomarker for the prognosis of patients undergoing arthroscopic‑assisted locking plate internal fixation in the treatment of high‑energy pilon fractures. Exp Ther Med 2024; 27:77. [PMID: 38264430 PMCID: PMC10804377 DOI: 10.3892/etm.2023.12365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/24/2023] [Indexed: 01/25/2024] Open
Abstract
The present study aimed to investigate the serum levels of caspase-1 in patients with high-energy pilon fractures, and its correlation with prognosis and clinical results. In this prospective study, 136 patients with high-energy pilon fractures who were treated with a locking plate combined with ankle arthroscopy from July 2015 to July 2020 were included. The treatment efficacy was evaluated according to the Mazur ankle function score. Serum caspase-1, interleukin (IL)-6, IL-1β and C-reactive protein (CRP) levels were measured using enzyme-linked immunosorbent assay. Reverse transcription-quantitative PCR was used to measure the mRNA expression of caspase-1. Additionally, demographic data and clinical characteristics, such as sex, age, intraoperative blood loss, fracture healing time, fracture classification and complications were collected and analyzed. The study revealed that the intraoperative blood loss, proportion of Ruedi-Allgower III and the serum levels of caspase-1 in the poor prognosis group were significantly higher compared with those in the good prognosis group. Additionally, patients with high-energy pilon fractures in the poor prognosis group exhibited significantly higher levels of caspase-1 and IL-1β serum levels at all time points in contrast to those in the good prognosis group. Spearman's analysis revealed a significant association between caspase-1, IL-1β levels and Mazur scores. Furthermore, caspase-1 could serve as a potential diagnostic biomarker for poor prognosis of patients with high-energy pilon fractures. Caspase-1, IL-1β, intraoperative blood loss and Ruedi-Allgower grade were the risk factors for poor prognosis in patients with high-energy pilon fractures. In summary, this study demonstrated that serum caspase-1 levels were progressively reduced during the treatment of high-energy pilon fractures patients and prominently lowered in those with a favorable prognosis. These findings could provide novel targets and a comprehensive approach to protecting patients with high-energy pilon fractures.
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Affiliation(s)
- Xiaoyu Gao
- Department of Orthopedics, Ordos Central Hospital, Ordos, Inner Mongolia Autonomous Region 017000, P.R. China
| | - Feng Liu
- Department of Orthopedics, Ordos Central Hospital, Ordos, Inner Mongolia Autonomous Region 017000, P.R. China
| | - Gang Wang
- Department of Orthopedics, Ordos Central Hospital, Ordos, Inner Mongolia Autonomous Region 017000, P.R. China
| | - Yu Gao
- Department of Orthopedics, Ordos Central Hospital, Ordos, Inner Mongolia Autonomous Region 017000, P.R. China
| | - Xin Suyalatu
- Department of Orthopedics, Ordos Central Hospital, Ordos, Inner Mongolia Autonomous Region 017000, P.R. China
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Liu J, Zhang Q, Wei G, Liu L, Mu X, Li M, Wu Z. Analysis of the Ability of a Distal Tibial Anatomical Locking Plate to Capture the Distal Tibial Fragments in Patients with Pilon Fractures. Orthop Surg 2023; 15:2674-2682. [PMID: 37533163 PMCID: PMC10549812 DOI: 10.1111/os.13796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 04/12/2023] [Accepted: 04/14/2023] [Indexed: 08/04/2023] Open
Abstract
OBJECTIVE Although pilon fractures are rare in clinical practice, they are difficult to treat because of their complexity. Effective fixation of the fracture fragment is the key to the treatment of pilon fractures. Plate osteosynthesis is common clinically, but there are many types of plates and the evaluation of the effect of fixation plates is not comprehensive. This study attempted to compare the capture effect of different fixation plates on the fracture fragments based on 3D modeling and fine distinctions of fracture fragments. METHODS The computed tomography (CT) images before treatment of 127 patients with pilon fractures from January 2019 to December 2021 were retrospectively collected. The fracture lines were mapped and digitally displayed as 3D images using MIMICS 21 software. APLUS distal tibia anatomical locking plate (Plate A) and ZIMMER distal tibia anatomical plate (Plate B) were placed on a pseudo-bone model and CT scans were used to determine the number of screws in the major and minor fragments of pilon fractures. The frequency of the two plates capturing the fracture fragments was recorded. RESULTS Under Assumption 1 or 2, Plate A performed significantly better than Plate B in capturing the major, Chaput, Volkmann, medial malleolus, and die-punch fracture fragments. Plate A captured markedly more minor fragments than Plate B under Assumption 2 but was not significantly different from Plate B under Assumption 1. Plate A or Plate B showed no obvious difference between major and minor capture rates under the same assumption, and A1 or B1 showed a markedly higher capture rate compared with A2 or B2. In addition, there was a significant positive correlation between the major capture rate and the major fragments in B1, and a significant negative correlation between the minor capture rate and the minor fragments in Plates A and B. However, there was no correlation between the major capture rate of Plate A and the major fragments. CONCLUSION The APLUS distal tibial anatomical locking plate is superior to the ZIMMER distal tibia anatomical plate in the ability to capture distal tibial fragments in pilon fracture cases.
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Affiliation(s)
- Jun‐Hong Liu
- Foot and Ankle Department 1Sichuan Orthopaedic HospitalChengduChina
| | - Qiang Zhang
- Foot and Ankle Department 1Sichuan Orthopaedic HospitalChengduChina
| | - Guo‐Hua Wei
- Foot and Ankle Department 1Sichuan Orthopaedic HospitalChengduChina
| | - Liang Liu
- Foot and Ankle Department 1Sichuan Orthopaedic HospitalChengduChina
| | - Xin Mu
- Foot and Ankle Department 1Sichuan Orthopaedic HospitalChengduChina
| | - Mao‐Lin Li
- Foot and Ankle Department 1Sichuan Orthopaedic HospitalChengduChina
| | - Zong‐De Wu
- Foot and Ankle Department 1Sichuan Orthopaedic HospitalChengduChina
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4
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Shafiq B, Zhang B, Zhu D, Gupta DK, Cubberly M, Stepanyan H, Rezzadeh K, Lim PK, Hacquebord J, Gupta R. Reducing Complications in Pilon Fracture Surgery: Surgical Time Matters. J Orthop Trauma 2023; 37:532-538. [PMID: 37226911 DOI: 10.1097/bot.0000000000002637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/19/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To correlate patient-specific and surgeon-specific factors with outcomes after operative management of distal intra-articular tibia fractures. DESIGN Retrospective cohort study. SETTING 3 Level 1 tertiary academic trauma centers. PATIENTS/PARTICIPANTS The study included a consecutive series of 175 patients with OTA/AO 43-C pilon fractures. MAIN OUTCOME MEASUREMENTS Primary outcomes included superficial and deep infection. Secondary outcomes included nonunion, loss of articular reduction, and implant removal. RESULTS The following patient-specific factors correlated with poor surgical outcomes: increased age with superficial infection rate ( P < 0.05), smoking with rate of nonunion ( P < 0.05), and Charlson Comorbidity Index with loss of articular reduction ( P < 0.05). Each additional 10 minutes of operative time over 120 minutes was associated with increased odds of requiring I&D and any treatment for infection. The same linear effect was seen with the addition of each fibular plate. The number of approaches, type of approach, use of bone graft, and staging were not associated with infection outcomes. Each additional 10 minutes of operative time over 120 minutes was associated with an increased rate of implant removal, as did fibular plating. CONCLUSIONS While many of the patient-specific factors that negatively affect surgical outcomes for pilon fractures may not be modifiable, surgeon-specific factors need to be carefully examined because these may be addressed. Pilon fracture fixation has evolved to increasingly use fragment-specific approaches applied with a staged approach. Although the number and type of approaches did not affect outcomes, longer operative time was associated with increased odds of infection, while additional fibular plate fixation was associated with higher odds of both infection and implant removal. Potential benefits of additional fixation should be weighed against operative time and associated risk of complications. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Babar Shafiq
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD
| | - Bo Zhang
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD
| | - Diana Zhu
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD
| | - Deven K Gupta
- Department of Orthopaedic Surgery, University of California, Irvine, CA; and
| | - Mark Cubberly
- Department of Orthopaedic Surgery, University of California, Irvine, CA; and
| | - Hayk Stepanyan
- Department of Orthopaedic Surgery, University of California, Irvine, CA; and
| | - Kevin Rezzadeh
- Department of Orthopaedic Surgery, New York University Langone Health, New York, NY
| | - Philip K Lim
- Department of Orthopaedic Surgery, University of California, Irvine, CA; and
| | - Jacques Hacquebord
- Department of Orthopaedic Surgery, New York University Langone Health, New York, NY
| | - Ranjan Gupta
- Department of Orthopaedic Surgery, University of California, Irvine, CA; and
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5
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Li X, Yu H, Li F, He Y, Xu L, Xiao J. Evaluation of effects of small-incision approach treatment on proximal tibia fracture by deep learning algorithm-based magnetic resonance imaging. Open Life Sci 2023; 18:20220624. [PMID: 37426618 PMCID: PMC10329276 DOI: 10.1515/biol-2022-0624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 04/26/2023] [Accepted: 05/08/2023] [Indexed: 07/11/2023] Open
Abstract
In this study, magnetic resonance imaging (MRI) based on a deep learning algorithm was used to evaluate the clinical effect of the small-incision approach in treating proximal tibial fractures. Super-resolution reconstruction (SRR) algorithm was used to reconstruct MRI images for analysis and comparison. The research objects were 40 patients with proximal tibial fractures. According to the random number method, patients were divided into a small-incision approach group (22 cases) and an ordinary approach group (18 cases). The peak signal-to-noise ratio (PSNR) and the structural similarity index (SSIM) of the MRI images before and after the reconstruction of the two groups were analyzed. The operative time, intraoperative blood loss, complete weight-bearing time, complete healing time, knee range of motion, and knee function of the two treatments were compared. The results showed that after SRR, the PSNR and SSIM of MRI images were 35.28 and 0.826 dB, respectively, so the MRI image display effect was better. The operation time in the small-incision approach group was 84.93 min, which was significantly shorter than that in the common approach group, and the intraoperative blood loss was 219.95 mL, which was significantly shorter than that in the common approach group (P < 0.05). The complete weight-bearing time and complete healing time in the small-incision approach group were 14.75 and 16.79 weeks, respectively, which were significantly shorter than those in the ordinary approach group (P < 0.05). The half-year knee range of motion and 1-year knee range of motion in the small-incision approach group were 118.27° and 128.72°, respectively, which were significantly higher than those in the conventional approach group (P < 0.05). After 6 months of treatment, the rate of good treatment was 86.36% in the small-incision approach group and 77.78% in the ordinary approach group. After 1 year of treatment, the rate of excellent and good treatment was 90.91% in the small-incision approach group and 83.33% in the ordinary approach group. The rate of good treatment for half a year and 1 year in the small incision group was significantly higher than that in the common approach group (P < 0.05). In conclusion, MRI image based on deep learning algorithm has a high resolution, good display effect, and high application value. The small-incision approach can be applied to the treatment of proximal tibial fractures, which showed good therapeutic effects and a high positive clinical application value.
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Affiliation(s)
- Xisheng Li
- Department of Orthopedics, The Second Affiliated Hospital (Jiande Branch), Zhejiang University School of Medicine, Jiande, Hangzhou, 311600 Zhejiang, China
| | - Huiling Yu
- Department of Orthopedics, The Second Affiliated Hospital (Jiande Branch), Zhejiang University School of Medicine, Jiande, Hangzhou, 311600 Zhejiang, China
| | - Fang Li
- Department of Orthopedics, The Second Affiliated Hospital (Jiande Branch), Zhejiang University School of Medicine, Jiande, Hangzhou, 311600 Zhejiang, China
| | - Yaping He
- Department of Orthopedics, The Second Affiliated Hospital (Jiande Branch), Zhejiang University School of Medicine, Jiande, Hangzhou, 311600 Zhejiang, China
| | - Liming Xu
- Department of Orthopedics, The Second Affiliated Hospital (Jiande Branch), Zhejiang University School of Medicine, Jiande, Hangzhou, 311600 Zhejiang, China
| | - Jie Xiao
- Department of Orthopedics, The Second Affiliated Hospital (Jiande Branch), Zhejiang University School of Medicine, Jiande, Hangzhou, 311600 Zhejiang, China
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6
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Flores M, Ciminero M, Kottmeier SA, Botros D, Zelle BA, Shearer DW. Pilon fractures: Consensus and controversy. OTA Int 2023; 6:e236. [PMID: 37533444 PMCID: PMC10392439 DOI: 10.1097/oi9.0000000000000236] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 12/08/2022] [Indexed: 08/04/2023]
Abstract
Pilon fractures are complex injuries that require an individualized approach to treatment to avoid complications and achieve good outcomes. Staged open reduction internal fixation remains the gold standard for most cases to achieve anatomic articular reduction while minimizing soft tissue complications and infection. Careful preoperative planning based on computed tomography dictates the surgical approach for reduction. A subset of cases may be amenable to early definitive or provisional open reduction and internal fixation based on fracture pattern. In some cases of severe articular comminution where reconstruction is not possible, primary ankle arthrodesis may be a good alternative.
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Affiliation(s)
- Michael Flores
- University of California, San Francisco, Department of Orthopaedic Surgery, San Francisco, CA
| | - Matthew Ciminero
- University of California, San Francisco, Department of Orthopaedic Surgery, San Francisco, CA
| | | | - Daniel Botros
- Stony Brook University, Department of Orthopaedic Surgery, Stony Brook, NY; and
| | - Boris A. Zelle
- UT Health San Antonio, Department of Orthopaedics, San Antonio, TX
| | - David W. Shearer
- University of California, San Francisco, Department of Orthopaedic Surgery, San Francisco, CA
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7
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Hreha J, Metrione MD, Reilly MC, Sirkin MS, Adams MR. Perioperative Impact of Early Limited Surgical Intervention to Treat Pilon Fractures. Foot Ankle Int 2022; 43:1092-1098. [PMID: 35642680 DOI: 10.1177/10711007221094024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The operative treatment of pilon fractures is classically treated with a staged protocol with ankle spanning external fixator, followed by definitive open reduction and internal fixation in order to decrease risk of soft tissue complications and infection. However, treatment of pilon fractures with patrial tibial fixation in addition to ankle spanning external fixation at the time of index procedure may facilitate final fixation while avoiding complications that were associated with acute definitive fixation. METHODS Retrospective cohort series of 113 patients treated for pilon fractures from September 2012 to November 2018 at a single level 1 trauma center. Charts were reviewed to compare patients who underwent traditional management with a staged protocol and those who had a limited tibial reduction and fixation (LTRF) during the index procedure. The main outcome measurement was time to definitive fixation. RESULTS Twenty-six percent of patients (29 of 113) had limited tibial reduction and fixation (LTRF) during index surgery. Mean time between index procedure and definitive ORIF was 4.75 days less for LTRF cohort compared to standard stage cohort (10.86 ± 7.44 vs. 15.61 ± 8.59 days, P = .009). The index procedure took on average 51 minutes longer in the LTRF cohort (P < .001), yet definitive procedure operative time was decreased by an average of 98 minutes (P < .001), and overall (index plus definitive) operative duration was shortened by an average of 50 minutes (P = .044). There was no difference in rate of infection between LTRF (3.1%) and traditional treatment (2.5%) (P = .86) or reduction quality (P = .270). There were no nonunions in either treatment group. CONCLUSION Patients who had LTRF had quicker time to definitive ORIF and decreased operative time for definitive ORIF. There was no difference in infection rate, reduction quality, or nonunion rate between groups. LEVEL OF EVIDENCE Level IV, Retrospective Cohort Study.
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Affiliation(s)
- Jeremy Hreha
- Department of Orthopaedic Surgery, Rutgers-New Jersey Medical School, Newark, NJ, USA
| | - Michael D Metrione
- Department of Orthopaedic Surgery, Rutgers-New Jersey Medical School, Newark, NJ, USA
| | - Mark C Reilly
- Department of Orthopaedic Surgery, Rutgers-New Jersey Medical School, Newark, NJ, USA
| | - Michael S Sirkin
- Department of Orthopaedic Surgery, Rutgers-New Jersey Medical School, Newark, NJ, USA
| | - Mark R Adams
- Department of Orthopaedic Surgery, Rutgers-New Jersey Medical School, Newark, NJ, USA
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8
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Patterson JT, Campbell ST, Wallace SJ, Magnusson EA, Elliott IS, Mertz K, Benirschke SK. Triceps Surae Lengthening in Foot and Ankle Trauma: A Survey of OTA and AOFAS Members. FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221126719. [PMID: 36199379 PMCID: PMC9528028 DOI: 10.1177/24730114221126719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: The prevalence, indications, and preferred methods for gastrocnemius recession and tendo-Achilles lengthening—grouped as triceps surae lengthening (TSL) procedures—in foot and ankle trauma are supported by a scarcity of clinical evidence. We hypothesize that injury, practice environment, and training heritage are significantly associated with probability of performing adjunctive TSL in the operative management of foot and ankle trauma. Methods: A survey was distributed to members of the American Orthopaedic Foot & Ankle Society and the Orthopaedic Trauma Association. Participants rated how likely they would be to perform TSL at initial management, definitive fixation, and after weightbearing in the presence and absence of a positive Silfverskiöld test in 10 clinical scenarios of closed foot and ankle trauma. Results: A total of 258 surgeons with median 14 years’ experience responded. Eighty-five percent reported foot and ankle fellowship training, 24% reported traumatology fellowship training, 13% both, and 4% no fellowship. Ninety-nine percent reported performing TSL with a median 25 TSL procedures per year, 72% open gastrocnemius recession, and 17% percutaneous tendo-Achilles lengthening). Across all scenarios, we observed low overall 8% probability with fair agreement (κ = 0.246) of performing TSL (range, 1% at initial management of an unstable Weber B bimalleolar ankle fracture with negative contralateral Silfverskiöld test to 29% at definitive fixation of tongue-type calcaneus fracture with positive contralateral Silfverskiöld test). Silfverskiöld testing significantly influenced TSL probability at all time points. University of Washington training (β = 1.5, P = .007) but not trauma vs foot fellowship training, years in practice, academic practice, urban setting, or facility trauma designation were significantly associated with likelihood of performing TSL. Conclusion: Orthopaedic traumatology and foot and ankle surgeons report similar indications, methods, and low perceived propensity to use TSL in the management of foot and ankle trauma. We found that graduates of 1 fellowship training site were more likely to perform TSL in the setting of acute trauma potentially indicating the need for better scientific data to support this practice. Level of Evidence: Level V, therapeutic.
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Affiliation(s)
- Joseph T. Patterson
- Department of Orthopaedic Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Sean T. Campbell
- Department of Orthopaedic Surgery, UC Davis Medical Center, Sacramento, CA, USA
| | | | | | | | - Kevin Mertz
- Department of Orthopaedic Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Stephen K. Benirschke
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA
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9
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Mair O, Pflüger P, Hoffeld K, Braun KF, Kirchhoff C, Biberthaler P, Crönlein M. Management of Pilon Fractures-Current Concepts. Front Surg 2022; 8:764232. [PMID: 35004835 PMCID: PMC8732374 DOI: 10.3389/fsurg.2021.764232] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/29/2021] [Indexed: 11/23/2022] Open
Abstract
Tibial pilon fractures were first described by Étienne Destot in 1911. He used the French word “pilon” (i.e., pestle), to describe the mechanical function of the distal tibia in the ankle joint. This term has further been used to portray the mechanism involved in tibial pilon fractures in which the distal tibia acts as a pestle with heavy axial forces over the talus basically causing the tibia to burst. Many different classification systems exist so far, with the AO Classification being the most commonly used classification in the clinical setting. Especially Type C fractures are extremely difficult to manage as the high energy involved in developing this type of injury frequently damages the soft tissue surrounding the fracture zone severely. Therefore, long -term outcome is often poor and correct initial management crucial. In the early years of this century treatment has evolved to a two–staged protocol, which nowadays is the gold standard of care. Additional methods of treating the soft tissue envelope are currently being investigated and have shown promising results for the future. The aim of this review is therefore to summarize protocols in managing these difficult fractures, review the literature on recent developments and therefore give surgeons a better understanding and ability to handle tibial pilon fractures.
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Affiliation(s)
- Olivia Mair
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Patrick Pflüger
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Kai Hoffeld
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Center for Orthopedic and Trauma Surgery, University Medical Center, Cologne, Germany
| | - Karl F Braun
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Trauma Surgery, Center for Musculoskeletal Surgery, Charité University Medicine Berlin, Berlin, Germany
| | - Chlodwig Kirchhoff
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Peter Biberthaler
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Moritz Crönlein
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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10
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Shu W, Hu X, Yang X. Comparison Between the Modified External Fixation and Calcaneal Traction in Ruedi-Allgower Type II/III Pilon Fractures. Med Sci Monit 2021; 27:e933385. [PMID: 34276043 PMCID: PMC8299870 DOI: 10.12659/msm.933385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background To compare the effect of modified external fixation and calcaneal traction in a staged management of Ruedi-Allgower type II/III tibial pilon fractures. Material/Methods The data of 62 patients with Ruedi-Allgower type II/III tibial pilon fractures who were treated in Liuzhou People’s hospital from January 2017 to December 2018 were extracted in this retrospective analysis. There were 32 patients in the temporary external fixation (TEF) group and 30 patients in calcaneal traction (CT) group. Outcomes, including the duration of the surgical procedure, pin track infection, degree of limb swelling, time to second-stage operation, postoperative comfort score, and visual analog scale (VAS) score, were compared. Results The effective rate of swelling reduction after treatment was 85% in the TEF group and 60% in the CT group; the average time to the second-stage operation was 8.34±1.29 days in the TEF group and 10.60±2.27 days in the CT group; the postoperative comfort scores were 70.1±3.2 and 61.3±3.5 in the TEF group and CT group, respectively; the postoperative VAS scores at 24 h, 48 h, and 7 days were 7.90±1.06, 4.88±0.83, 2.72±1.14 in TEF group, and 8.50±0.86, 6.27±1.36, 3.57±1.19 in CT group, respectively. There were 1 case of pin tract infection identified in the TEF group and 4 in the CT group. All differences were statistically significant (P<0.05). Conclusions The modified external fixation is more effective than calcaneal traction in treatment of Ruedi-Allgower type II/III tibial pilon fractures in the first-stage of combined management.
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Affiliation(s)
- Wen Shu
- Department of Trauma Orthopedics, Liuzhou People's Hospital, Liuzhou, Guangxi, China (mainland)
| | - Xiaodong Hu
- Department of Trauma Orthopedics, Liuzhou People's Hospital, Liuzhou, Guangxi, China (mainland)
| | - Xiaofan Yang
- Department of Trauma Orthopedics, Liuzhou People's Hospital, Liuzhou, Guangxi, China (mainland)
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11
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Oki S, Kobayashi H, Kubota H, Umezu T, Nagasaki M, Iwabu S. A Pilon Fracture With Fibular Head Dislocation Treated With the Use of 3D Preoperative Planning: A Case Report and Literature Review. J Foot Ankle Surg 2021; 60:404-407. [PMID: 33423890 DOI: 10.1053/j.jfas.2020.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 07/10/2020] [Accepted: 09/29/2020] [Indexed: 02/03/2023]
Abstract
Pilon fractures with intact fibula have been associated with low-energy trauma. However, the compression force onto the ankle joint can damage the tibiofibular linkage as in a Maisonneuve fracture. Herein, we describe a case of a patient who had a pilon fracture (AO type 43 C3.2) without a fibular fracture. Three-dimensional preoperative simulation by reduction with the surface registration technique was performed as the fibular length was intact and there was no reference for the tibial length. The preoperative simulation revealed superior fibular head dislocation and shortening of the distal tibia. After emergency external fixation on the day of arrival, a 2-staged surgery was performed. During the first operation, the fibular head was reduced and the tibial posterolateral fragment was fixed to restore the tibia length. During the second operation, medial and anterolateral fragments were fixed in order to reduce joint surface of the distal tibia. In general, proximal fibular head fractures are easily overlooked. In the case of pilon fractures with severe length shortening of the tibia without a fibular fracture, a proximal tibiofibular injury should be suspected.
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Affiliation(s)
- Satoshi Oki
- Orthopedic Surgeon, Department of Orthopedic Surgery, Saiseikai Utsunomiya Hospital, Tochigi, Japan; Orthopedic Surgeon, Department of Clinical Biomechanics, Keio University School of Medicine, Tokyo Japan.
| | - Hiroki Kobayashi
- Orthopedic Surgeon, Department of Orthopedic Surgery, Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | - Hidejiro Kubota
- Orthopedic Surgeon, Department of Orthopedic Surgery, Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | - Taro Umezu
- Orthopedic Surgeon, Department of Orthopedic Surgery, Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | - Minoru Nagasaki
- Physical Therapist, Department of Rehabilitation Medicine, Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | - Shohei Iwabu
- Orthopedic Surgeon, Department of Orthopedic Surgery, Saiseikai Utsunomiya Hospital, Tochigi, Japan
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BİÇİCİ V, BİNGÖL İ. Do different surgical techniques in tibia pilon fractures change the results of the midterm? Turk J Med Sci 2020; 50:1559-1565. [PMID: 32892545 PMCID: PMC7605097 DOI: 10.3906/sag-2006-212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 08/29/2020] [Indexed: 11/03/2022] Open
Abstract
Background/aim Pilon fracture is difficult to treat fractures due to many complications that can develop after surgery. To achieve the best results, different surgical approaches are used.In our study, we aimed to compare the functional results and complication rates of our treatments in patients treated with 3 different surgical tecniques. Materials and methods 89 pilon fractures of 87 patients treated for pilon fracture were evaluated. Patients were examined in 3 different groups (one step, two step surgery and Ilizarov). Functional results, postoperative complications and ankle AOFAS scores were evaluated. Results The mean AOFAS score of the all patients was 77.67. There was no significant difference between 3 surgical techniques (P = 0,880). While skin complication was not seen in patients who underwent double-stage surgery and Ilizarov (0%); It was seen in 6 (15.7%) patients who underwent single-stage surgery. Treatment results were found to be better in type 1 and type 2 fractures, while in type 3 fractures (P = 0.004). Conclusion Despite the different surgical approaches and implants applied, no difference was found between the midterm ankle functional results of the patients. Two-stage surgery and Ilizarov is a safe and effective treatment approach to reduce morbidity and early complications in pilon fractures.
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Affiliation(s)
- Vedat BİÇİCİ
- Department of Orthopaedics and Traumatology, Ankara City Hospital, AnkaraTurkey
| | - İzzet BİNGÖL
- Department of Orthopaedics and Traumatology, 29 Mayıs Goverment Hospital, AnkaraTurkey
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Mitsuzawa S, Takeuchi H, Ando M, Sakazaki T, Ikeguchi R, Matsuda S. Comparison of four posterior approaches of the ankle: A cadaveric study. OTA Int 2020; 3:e085. [PMID: 33937708 PMCID: PMC8022904 DOI: 10.1097/oi9.0000000000000085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/30/2020] [Accepted: 05/13/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The purpose of this study is to provide a detailed comparison of 4 posterior approaches of the ankle: the posteromedial, modified posteromedial (mPM), Achilles tendon-splitting (TS), and posterolateral approaches. METHODS Cadaveric dissections were performed to assess the influence of the medial and lateral retraction forces on the neuro-vascular bundle with suspension scales and to measure the medial and lateral exposed areas of the posterior tibia and talus. Data was acquired with the ankle in neutral position and in plantar flexion. RESULTS Both the mPM and TS approaches provided excellent visualization of the posterior tibia with the ankle in plantar flexion (16.6 cm2 and 16.2 cm2, respectively). The medial aspect of the posterior tibia, however, was significantly better exposed in the mPM approach than in the TS approach with the ankle in neutral position (8.9 cm2 vs 6.5 cm2). The lower value for medial retraction force in the mPM approach (1.9 N in neutral position and 0.9 N in plantar flexion) indicated a lower risk of injury to the neuro-vascular bundle (the tibial nerve and the posterior tibial artery). The posterior talus, however, is best visualized through the TS approach with the ankle in neutral position (4.5 cm2). CONCLUSIONS The current study demonstrated the usefulness of the mPM approach. When internal fixation of the fibula is unnecessary, the mPM approach is preferable, considering the potential damage to the Achilles tendon associated with the TS approach.
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