Lu Ming,Yang Zheng,You Haifeng,et al.Midterm follow-up surgical outcomes of pediatric Pilon fracture[J].Journal of Clinical Pediatric Surgery,,18():594-599.[doi:10.3969/j.issn.1671-6353.2019.07.015]
Midterm follow-up surgical outcomes of pediatric Pilon fracture
- Keywords:
- Fractures; Bone; External Fixators; Orthopedic Procedures
- CLC:
- R726.8;R687.4+3
- Abstract:
- Objective Pilon fractures are rare in children and skeleton-immature adolescents.The purpose of this study was to summarize the surgical efficacies of pediatric Pilon fractures and enhance the understanding of this special type of fractures so as to explore the formulation of appropriate treatment,reduce the incidence of complications and maximize the recovery of ankle function.Methods From January 2011 to January 2017,21 cases of pediatric Pilon fracture were collected.The average age was 135 (98-171) months and the mean follow-up period 51 (19-92) months.According to the Letts classification,the clinical types were Ⅰ(n=2),Ⅱ(n=6) and Ⅲ(n=13).All patients had concurrent fibular fractures and 12 cases concurrent talus fractures.Results Seven patients underwent open reduction and internal fixation and 13 cases underwent ankle spanning external fixation plus limited internal fixation due to severe soft tissue swelling or difficulty of maintaining the reduction of ankle dislocation.One case was treated conservatively with cast immobilization because of mild injury.According to the Helfet’s criteria,the outcomes were excellent (n=10),good (n=8) and poor (n=3) at the final follow-up.Excellent-to-good outcomes were observed in 85.7% cases.Talus osteonecrosis occurred in 3 cases and 4 cases suffered from growth arrest of distal tibia resulting in ankle varus or valgus deformity.There was no onset of osteomyelitis or deep infection.One case undergoing local skin flap transfer due to skin necrosis healed well.Conclusion For pediatric Pilon fracture with ankle dislocation or severe soft tissue injury,ankle spanning external fixator plus limited internal fixation is a preferred option.
References:
1 Destot E.Traumatismes du pied et rayons X:maleoles.astragale,calacneum,avant-pied[J].Journal of the American Medical Association,1938,110(25):2017.
2 Mandracchia VJ,Evans RD,Nelson SC,et al.Pilon fractures of the distal tibia[J].Clin Podiatr Med Surg,1999,16(4):743-767.
3 Bone L,Stegemann P,McNamara K,et al.External fixation of severely comminuted and open tibial Pilon fractures[J].Clin Orthop,1993,292,101-107.DOI:10.1097/00003086-199307000-00012.
4 Letts M,Davidson D,McCaffrey M,et al.The adolescent Pilon fracture:management and outcome[J].J Pediatr Orthop,2001,21(1):20-26.DOI:10.1097/01241398-200101000-00006.
5 Helfet DL,Koval K,Pappas J,et al.Intraarticular Pilon fracture of the tibia[J].Clin Orthop,1994,298:221-228.DOI:10.1097/00003086-199401000-00029.
6 Ruedi T,Allgower M.Fractures of the lower end of the tibia into the ankle-joint:results of nine years after open reduction and internal fixation[J].Injury,1973,5(2):130.DOI:10.1016/s0020-1383(73)80089-0.
7 Ruedi T,Allgower M.The operative treatment of intra-articular fractures of the lower end of the tibia[J].Clin Orthop,2011,9(01):23-25.
8 Karas EH,Weiner LS.Displaced Pilon fractures:an update[J].Orthop Clin North Am,1994,25(4):651-663.
9 Teeny SM,Wiss DA.Open reduction and internal fixation of tibial plafond fractures:variables contributing to poor results and complications[J].Clin Orthop,1993,292:108-117.DOI:10.1097/00003086-199307000-00013.
10 Kendig RJ.Operative treatment of fractures of the tibial plafond:a randomized,prospective study[J].J Bone Joint Surg Am,1996,78(1):1646-1657.DOI:10.3928/01477447-20110714-17.
11 Babis GC,Vayanos ED,Papaioannou N,et al.Results of surgical treatment of tibial plafond fractures[J].Clin Orthop,1997,341:99-105.DOI:10.1097/00003086-199708000-00016.
12 Ruedi T,Allgower M.Fractures of the lower end of the tibia into the ankle-joint[J].Orthepedic Trauma Directions,2009,7(05):25-29.DOI:10.1055/s-0028-1100867.
13 Tarkin IS,Clare MP,Marcantonio A,et al.An update on the management of high-energy Pilon fractures[J].Injury,2008,39(2):142-154.DOI:10.1016/j.injury.2007.07.024.
14 Sirkin M,Sanders R,Di Pasquale T,et al.A staged protocol for soft tissue management in the treatment of complex Pilon fractures[J].J Orthop Trauma,2008,6(04):31-33.
15 Bonar SK,Marsh JL.Unilateral external fixation for severe Pilon fractures[J].Foot Ankle,1993,14(2):57-64.DOI:10.1177/107110079301400201.
16 Leone VJ,Ruland RT,Meinhard BP.The management of the soft tissues in Pilon fractures[J].Clin Orthop,1993,292:315-320.DOI:10.1097/00003086-199307000-00041.
17 Tornetta Ⅲ P,Weiner L,Bergman M,et al.Pilon fractures:treatment with combined internal and external fixation[J].J Orthop Trauma,1993,7(6):489-496.DOI:10.1097/00005131-199312000-00001.
18 Papadokostakis G,Kontakis G,Giannoudis P,et al.External fixation devices in the treatment of fractures of the tibial plafond.A systematic review of the literature E[J].J Bone Joint Surg Br,2008,90-B(1):1-6.DOI:10.1302/0301-620X.90B1.19858.
19 Heim U,Naser M.Die operative behadlung der Pilon-tibial-fraktur.technik der osteosynthese und resultate bei 128 petienten[J].Arch Orthop,1976,86(3):341-356.DOI:10.1007/bf00418910.
20 Meena UK,Bansal MC,Behera P,et al.Evaluation of functional outcome of Pilon fractures managed with limited internal fixation and external fixation:A prospective clinical study[J].J Clin Orthop Trauma,2017,8:16-20.DOI:10.1016/j.jcot.2017.05.005.
Memo
收稿日期:2018-11-25。
通讯作者:郭源,Email:gy0902@sina.com