Meta-plate and mini-plate internal fixation for the treatment
of anterior comminuted coronal plane Pilon fractures

doi:10.3969/j.issn.2095-4344.2412

Chinese Journal of Tissue Engineering Research ›› 2020, Vol. 24 ›› Issue (3): 378-382.doi: 10.3969/j.issn.2095-4344.2412

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Meta-plate and mini-plate internal fixation for the treatment of anterior comminuted coronal plane Pilon fractures

Wei Daiqing, Li Cui, Xiang Feifan, Deng Yong, Lu Xiaobo, Xu Yangbo

Department of Bone and Joint Surgery, Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China

Received:2019-04-09 Revised:2019-04-18 Accepted:2019-06-12 Online:2020-01-28 Published:2019-12-25
Contact: Xu Yangbo, Master, Associate chief physician, Department of Bone and Joint Surgery, Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
About author:Wei Daiqing, MD, Lecturer, Department of Bone and Joint Surgery, Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
Supported by:
the Sichuan Provincial Department of Education Research Project, No. 18ZA0533; the Sichuan Provincial Health and Family Planning Commission Research Project, No. 16PJ549; the Southwest Medical University Financial Supporting Plan, No. 2014ZD-012; the Affiliated Hospital of Southwest Medical University Research Project, No. 15049

Abstract

Abstract:

BACKGROUND: Pilon fractures usually happened during severe injury, associated with compression and comminution of metaphysis and soft tissue injury and primary articular cartilage damage in varying degrees.The treatment is difficult and the prognosis is relatively poor.

OBJECTIVE: To explore the clinical effect of application of meta-plate and mini-plate internal fixation for the treatment of anterior comminuted coronal plane Pilon fractures.

METHODS: From January 2013 to June 2017, 17 patients of closed anterior comminuted coronal plane Pilon fractures were admitted in Department of Bone and Joint Surgery, Affiliated Hospital of Southwest Medical University. There were 7 males and 10 females, aged from 24 to 62 years, with an average age of 41.3 years. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. Preoperative CT scans and three-dimensional reconstruction confirmed that the main fracture line was in coronal plane and multiple fragments of distal tibial metaphysis were displaced obviously. According to Rüedi-Allgöwer classification, there were 3 cases of type II and 14 cases of type III. Fracture fragments of articular surface were fixed with transverse metacarpophalangeal mini-plate and screws, and the distal tibial coronal fractures were fixed with anterior meta-plate. The ankle and hind foot score of the American Orthopaedic Foot and Ankle Society was used to evaluate the function after surgery.

RESULTS AND CONCLUSION: (1) The 17 patients were followed up for 12 to 28 months. All incisions healed in the first stage without complications such as wound infection, skin necrosis, failure of internal fixation and neurovascular injury. Only one patient had redness on the edge of the incision after operation and healed after swelling reduction and dressing change. (2) Fractures healed within 3 to 6 months without delayed union or nonunion. (3) At the last follow-up, the American Orthopaedic Foot and Ankle Society ankle and hind foot score was excellent in 10 cases, good in 5 cases, and average in 2 cases. The excellent and good rate was 88%. (4) The application of transverse mini-plate and screws fixation can effectively support and fix the fracture fragments of articular surface. Combined with anterior meta-plate of distal tibia for the treatment of anterior comminuted coronal plane Pilon fractures can achieve good therapeutic effect, and strengthen biomechanical stability.

Key words: coronal plane, Pilon fracture, mini-plate, meta-plate, open reduction and internal fixation, fracture healing

CLC Number:

Wei Daiqing, Li Cui, Xiang Feifan, Deng Yong, Lu Xiaobo, Xu Yangbo. Meta-plate and mini-plate internal fixation for the treatment of anterior comminuted coronal plane Pilon fractures[J]. Chinese Journal of Tissue Engineering Research, 2020, 24(3): 378-382.

Figures/Tables 3

References

[1] BORRELLI J, ELLIS E. Pilon fractures: assessment and treatment. Orthop Clinf North Am. 2002;33(1):231-245.
[2] MANDI DM, BELIN RP, BANKS J, et al. Pilon fractures. Clin Podiatr Med Surg. 2012;29(2):243-278.
[3] MAUFFREY C, VASARIO G, BATTISTON B, et al. Tibial pilon fractures: a review of incidence, diagnosis, treatment, and complications. Acta Orthopaedica Belgica. 2011;77(4):432-440.
[4] KOTTMEIER SA, MADISON RD, DIVARIS N. Pilon Fracture: Preventing Complications. J Am Acad Orthop Surg. 2018;26(18): 640-651.
[5] ZELLE BA, DANG KH, ORNELL SS. High-energy tibial pilon fractures: an instructional review. Int Orthop. 2019; 43(8):1939-1950.
[6] LIANGJUN J, QIANG Z, HANG L, et al. Injury mechanism, fracture characteristics and clinical treatment of pilon fracture with intact fibula-A retrospective study of 23 pilon fractures. J Clin Orthop Trauma. 2017; 8(Suppl 2):S9-S15.
[7] KOTTMEIER SA, MADISON RD, Divaris N. Pilon fracture: preventing complications. J Am Acad Orthop Surg. 2018;26(18):640-651.
[8] TOMÁS-HERNÁNDEZ J. High-energy pilon fractures management: State of the art. Efort Open Rev. 2017;1(10):354-361.
[9] SCAGLIONE M, CELLI F, CASELLA F, et al. Tibial pilon fractures treated with hybrid external fixator: analysis of 75 cases. Musculoskelet Surg. 2019;103(1):83-89.
[10] MANEGOLD S, SPRINGER A, MÄRDIA S, et al. Treatment Algorithm for Pilon Fracture - Clinical and Radiological Results. Acta Chir Orthop Traumatol Cech. 2019; 86(1):11-17.
[11] WIEBKING U. Pilon fractures: Review of diagnostics and classification. Der Unfallchirurg. 2017;120(8):632-639.
[12] 王彦超,徐小雄. 高能量胫骨pilon骨折的诊疗进展[J].中华创伤杂志, 2014,30(1):88-91.
[13] 贾斌,张勇,李郑林,等. Pilon骨折的CT分型及其临床指导意义[J]. 中国骨伤,2011,24(6):470-473.
[14] 王智祥,魏世隽,蔡贤华. 胫骨Pilon骨折分型现状[J].中国矫形外科杂志, 2018, 26(6):533-537.
[15] TOPLISS CJ, JACKSON M, ATKINS RM. Anatomy of pilon fractures of the distal tibia. J Bone Joint Surg Br. 2005;87(5):692-697.
[16] LEONETTI D, TIGANI D. Pilon fractures: A new classification system based on CT-scan. Injury. 2017;48(10):2311-2317.
[17] TANG X, LIU L, TU CQ, et al. Comparison of Early and Delayed Open Reduction and Internal Fixation for Treating Closed Tibial Pilon Fractures. Foot Ankle Int. 2014;35(7):657-664.
[18] WHITE TO, GUY P, COOKE CJ, et al. The results of early primary open reduction and internal fixation for treatment of OTA 43.C-type tibial pilon fractures: a cohort study. J Orthop Trauma. 2010;24(12): 757-763.
[19] BEAR J, ROLLICK N, HELFET D. Evolution in Management of Tibial Pilon Fractures. Curr Rev Musculoskelet Med. 2018;11(4): 537-545.
[20] MATHEWS JA, WARD J, CHAPMAN TW, et al. Single-stage orthoplastic reconstruction of Gustilo-Anderson grade III open tibial fractures greatly reduces infection rates. Injury. 2015;46(11): 2263-2266.
[21] ZHANG SB, ZHANG YB, WANG SH, et al. Clinical efficacy and safety of limited internal fixation combined with external fixation for pilon fracture: a systematic review and meta-analysis. Chin J Traumatol. 2017;20(2):94–98.
[22] CUI X, CHEN H, RUI Y, et al. Two-stage open reduction and internal fixation versus limited internal fixation combined with external fixation: a meta-analysis of postoperative complications in patients with severe Pilon fractures. J Int Med Res. 2018;46(7): 2525-2536.
[23] WARNER SJ, LORICH DG. Surgical Approach Options for Pilon Fractures. Tech Foot Ankle Surg. 2016;15(4):169-174.
[24] LIU J, SMITH CD, WHITE E, et al. A systematic review of the role of surgical approaches on the outcomes of the tibia pilon fracture. Foot Ankle Spec. 2015;9(2):163-168.
[25] ANEJA A, LUO TD, LIU B, et al. Anterolateral distal tibia locking plate osteosynthesis and their ability to capture ota c3 pilon fragments. Injury. 2018; 49(2):409-413.
[26] 高彦军,张勇,郑杰,等. 前侧pilon骨折的诊断和治疗[J].中华创伤杂志, 2016, 32(5):423-426.
[27] 孙辽军,陈华,郭晓山,等.胫骨远端前方Meta钢板治疗冠状面Pilon骨折[J]. 中医正骨,2009,21(1):36-37.
[28] 李海平,刘观燚,徐荣明,等. Meta钢板内固定治疗HaraguchiⅡ型后踝骨折[J]. 中国骨与关节损伤杂志, 2014,29(2):158-159.
[29] 马童,蔡珉巍,刘晓东,等. Meta接骨板与锁定钢板置入内固定治疗胫骨远端干骺端骨折的比较[J]. 中国组织工程研究,2011,15(35):6518-6521.
[30] 倪宏伟. Meta接骨板治疗Pilon骨折的初步体会[J].中国矫形外科杂志, 2007,15(16):1266-1267.

Meta-plate and mini-plate internal fixation for the treatment of anterior comminuted coronal plane Pilon fractures

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