Effective fixation of double plates for delayed treatment of type C pilon fractures

doi:10.3969/j.issn.2095-4344.2014.04.014

Abstract

Abstract:

BACKGROUND: Traditional open reduction and internal fixation for type C pilon fractures is characterized extensive periosteal stripping, severe soft tissue injury, many postoperative complications, and unsatisfactory recovery of joint function. Minimally invasive technology or external fixation combined with limited internal fixation for type C pilon fractures are usually difficult to achieve anatomical reduction.

OBJECTIVE: To explore the curative efficacy of anterolateral “L” type locking plate implantation combined with interior minimally invasive plate osteosynthesis in treatment of type C pilon fractures and postoperative complication occurrence in order to find out the efficient fixation method for type C pilon fractures.

METHODS: Twenty-six patients with type C pilon fractures (15 males and 11 females, aged from 19 to 68 years, mean age of 39.2 years) were selected and subjected to anterolateral “L” type locking plate implantation combined with interior minimally invasive plate osteosynthesis. CT three-dimensional reconstruction was performed before and plate implantation. X-ray examination was carried out before and after fixation. All patients were followed up for observation of clinical efficacy and complications. The therapeutic effects were evaluated using the Johner-Wruhs scoring system.

RESULTS AND CONCLUSION: The 26 patients were followed up for 16 months (from 9 to 24 months). Delayed healing occurred in one case (after 12 months), and the average healing time was 15 weeks (from 11 to 52 weeks). There was no deformity healing. Two patients developed superficial incision infections of Staphylococcus aureus, healed by open wound and dressing change every day for 2 weeks. No deep infection or osteomyelitis was found. One patient was found to have traumatic arthritis of ankle joint, improved by the injection of sodium hyaluronate. There was no flap necrosis and tendon irritation, broken nail or screw withdrawal, and nerve injury. Johner-Wruhs scores were excellent in 11 cases, good in 12 cases, fair in 3 cases, with the total excellent to good rate of 88.5%. These findings indicate that anterolateral “L” type locking plate implantation combined with interior minimally invasive plate osteosynthesis for delayed treatment of type C pilon fractures can achieve satisfactory fracture reduction, rigid fixation, early functional exercise, less complications, and good recovery of joint function.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: tibial fractures, fracture fixation, fractures, open, weight-bearing

CLC Number:

R318

Wang Ti-hui, Su Yu, Wang Xu, Liu Shou-kun, Wang Xiao-lu. Effective fixation of double plates for delayed treatment of type C pilon fractures[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(4): 571-576.

Figures/Tables 2

2.1 参与者数量分析 26例患者均获随访，平均随访16个月(9-24个月)，无中途退出者。 2.2 前外侧“L”型锁定钢板置入结合内侧微创经皮接骨板技术延期治疗C型Pilon骨折患者的住院至手术时间闭合性骨折15例，平均5.8 d(5-7 d)，Gustilo Ⅰ型骨折患者11例，平均8.3 d(7-10 d)。 2.3 前外侧“L”型锁定钢板置入结合内侧微创经皮接骨板技术延期治疗C型Pilon骨折患者的影像学观察结果本组26例患者，固定后随访关节面移位< 5 mm，下肢力线正常，内外踝间隙对称，骨折均获愈合，X射线骨愈合时间均数为(15.1±1.2)周，无畸形愈合，1例延迟愈合，完全负重时间均数为(16.3±1.7)周。根据Burwell-Charnley影像学评价标准[3]判定骨折复位质量，关节面获得解剖复位19例，复位可7例，无内固定物进入关节内。 2.4 前外侧“L”型锁定钢板置入结合内侧微创经皮接骨板技术延期治疗C型Pilon骨折患者的Johner-Wruhs评分结果按照Johner-Wruhs评分标准评分，功能优11例，良12例，中3例，优良率88.5%。 2.5 Pilon骨折患者固定后踝关节功能恢复情况按照Johner-Wruhs评分标准评分，骨折类型AO/OTA C1共8例，优6例，良2 例，中0例，优良率100%；骨折类型AO/OTA C2共11例，优3例，良7例，中1例，优良率91%；骨折类型AO/OTA C3共7例，优2例，良3 例，中2例，优良率71%；结果说明C1型与C2型骨折患者固定后踝关节功能恢复情况无明显差异，C3型骨折患者优良率稍差。 2.6 开放性骨折与闭合性骨折患者临床功能恢复情况对比开放性骨折11例，优5例，良5例，中1例，优良率91%；闭合性骨折15例，优6例，良7例，中2例，优良率87%。结果说明开放性骨折与闭合性骨折患者在踝关节功能恢复情况无明显差异。 2.7 前外侧“L”型锁定钢板置入结合内侧微创经皮接骨板技术延期治疗C型Pilon骨折患者的并发症分析固定后患者浅层感染2例，均为金黄色葡萄球菌，予敞开伤口每天换药2周后愈合；无深层感染或骨髓炎；创伤性关节炎1例，予踝关节注射玻璃酸钠后好转；无皮瓣坏死；无肌腱激惹；无断钉或退钉现象；无神经损伤。 2.8 与材料有关的不良反应分析除伤口感染的2例患者外，其余患者局部无炎症、过敏、组织增生、材料腐蚀或生物降解等材料宿主反应；全身无凝血功能异常、癌变或免疫反应等。 2.9 典型病例典型病例1(图2)。典型病例2(图3)。"

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