The treatment of severe open Pilon frac-tures

曾憲鐵(Zeng Xiantie，Dept Orthop Surg，Tianjin Hosp，Tianjin 300211)…∥Chin J Orthop.－ 2010，30(12).－1192～1196

The treatment of severe open Pilon frac-tures

曾憲鐵(Zeng Xiantie，Dept Orthop Surg，Tianjin Hosp，Tianjin 300211)…∥Chin J Orthop.－ 2010，30(12).－1192～1196

ObjectiveTo discuss the operative methods，timing and outcomes of severe open Pilon fractures.MethodsFrom April 2003 to July 2008，21 patients with open Pilon fractures were admitted.All the patients were type C fracture according to AO/OTA classification，including 17 cases of type C2 and 4 cases of type C3.According to Gustilo classification，there were 18 cases of type Ⅱ，2 cases of typeⅢA，1 case of typeⅢB.The patients were treated in two different ways:one-stage minimally invasive osteosynthesis for reconstruction of the articular surface with transarticular external fixation of the ankle(19 cases)，which included 16 cases of Gustilo ⅡAO/OTA C2，2 cases of type Gustilo Ⅱ AO/OTA C3 and 1 case of type Gustilo ⅢA AO/OTA C2.Formal open reconstruction of the articular surface by plating and external fixation was performed when the condition of soft tissue had improved(2 cases)，which included 1 cases of type GustiloⅢA AO/OTA C3 and 1 cases of type GustiloⅢ B AO/OTA C3.ResultsAll the patients were followed up from 6 to 48 months，with the mean of 24 months.The outcome of reduction was evaluated by the Burwell-Charnley score.Anatomical reduction was found in 6 cases，function reduction was in 14 cases and poor reduction was 1 case.The heal-time ranged from 2.5 to 11 months，with the mean of 4.7 months.The delayed union occurred in 2 cases.The rate of delayed union was 9.5%.Two patients experienced skin superficial necrosis.There were superficial infection in 2 cases and deep infection in 1 case.The infection rate was 14.3% .Eight cases experienced early traumatic arthritis.The incidence of this complication was 38.1%.According to American Orthopedic Foot Ankle Society(AOFAS)scale for ankle joint，the result of the treatment was 66 －94，with an average of 85.2.ConclusionIt is important to have the optimal timing of surgery and reliable fixation according to fracture classification，the condition of soft tissue and time after injury.It is the key to evaluate the condition of soft tissue and protect the blood supply.21 refs，2 figs，2 tabs.

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