EFFECTIVENESS OBSERVATION OF STAGED TREATMENT OF OPEN Pilon FRACTURE COMBINED WITH SOFT TISSUE DEFECT_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIU Zhong , XU Hong , ZHANG Zhao , TENG Yunsheng , WU Meng , TAO Shenglin.

Department of Traumatic Orthopaedics, Xi’an Ordnance Industrial 521 Hospital, Institute of Hand Microsurgery of Shaanxi, Xi’an Shaanxi, 710065, P.R.China. Corresponding author: TENG Yunsheng, E-mail: csgk521@126.com;

Corresponding author：

Keywords：

Pilon fracture; Open fracture; Staged treatment; Wound repair

DOI：

10.7507/1002-1892.20130260

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Objective To explore the effectiveness of staged treatment of open Pilon fracture combined with soft tissue defect. Methods Between June 2007 and December 2012, 18 cases of open Pilon fracture combined with soft tissue defect were treated. There were 14 males and 4 females with an average age of 35 years (range, 19-55 years). The causes of injury included falling from height in 12 cases, traffic accident in 4 cases, and crushing by machine in 2 cases. According to AO classification, 1 case was classified as type B2 fracture, 3 cases as type B3 fracture, 5 cases as type C1 fracture, 5 cases as type C2 fracture, and 4 cases as type C3 fracture. Sixteen cases accompanied by fibular fracture (14 cases of simple fibular fracture and 2 cases of communicated fibular fracture). According to Gustilo classification, the soft tissue injuries were all type IIIB. In first stage, debridement and vaccum sealing drainage combined with external fixation were performed; open reduction and internal fixation of simple fibular fracture were used. In second stage, open reduction and internal fixation of Pilon fracture and communicated fibular fracture were performed, and the flaps of 6 cm × 5 cm to 18 cm × 14 cm were applied to repair soft tissue defect at the same time. The donor site was repaired by skin graft. Results Partial necrosis occurred in 2 flaps, the other 16 flaps survived completely. The incisions of donor sites healed by first intention, the skin graft survived completely. The average follow-up interval was 12 months (range, 6-24 months). The X-ray films showed that the bone healing time ranged from 5 to 8 months (mean, 6 months). No internal fixation failure was found. At last follow-up, the average range of motion of the ankle joint was 37° (range, 26-57°). According to the American Orthopedic Foot and Ankle Society (AOFAS) scale, the average score was 80.2 (range, 72-86). Traumatic arthritis occurred in 2 cases (11%). Conclusion The staged treatment has the advantages of accurate evaluation of soft tissue injury, shortened cure time, good reduction of the articular surface, and reduced incidence of infection, so it is an optimal method to treat open Pilon fracture combined with soft tissue defect.

Citation： LIU Zhong,XU Hong,ZHANG Zhao,TENG Yunsheng,WU Meng,TAO Shenglin.. EFFECTIVENESS OBSERVATION OF STAGED TREATMENT OF OPEN Pilon FRACTURE COMBINED WITH SOFT TISSUE DEFECT. Chinese Journal of Reparative and Reconstructive Surgery, 2013, 27(10): 1185-1189. doi: 10.7507/1002-1892.20130260 Copy

1.	Rammelt S, Endres T, Grass R, et al. The role of external fixation in acute ankle trauma. Foot Ankle Clin, 2004, 9(3): 455-474.
2.	Boraiah S, Kemp TJ, Erwteman A, et al. Outcome following open reduction and internal fixation of open pilon fractures. J Bone Joint Surg (Am), 2010, 92(2): 346-352.
3.	陈大伟, 李兵, 俞光荣. Pilon骨折的切开复位内固定治疗进展. 中华创伤骨科杂志, 2013, 15(3): 235-238.
4.	Hess F, Sommer C. Minimally invasive plate osteosynthesis of the distal fibula with the locking compression plate: first experience of 20 cases. J Orthop Trauma, 2011, 25(2): 110-115.
5.	孙鸿涛, 黄枫, 周琦石, 等. 自体髂骨移植重建胫骨pilon骨折胫骨远端关节面缺损的临床疗效. 中华创伤骨科杂志, 2011, 13(7): 649-652.
6.	Koshima I, Nanba Y, Tsutsui T, et al. Perforator flaps in lower extremity reconstruction. Handchir Mikrochir Plast Chir, 2002, 34(4): 251-256.
7.	俞光荣, 陈大伟, 赵宏谋, 等. 支撑钢板治疗后侧pilon骨折的疗效分析. 中华创伤杂志, 2013, 29(3): 243-246.
8.	魏世隽, 蔡贤华, 刘曦明, 等. 有限切开复位结合锁定加压接骨板内固定治疗胫骨Pilon骨折. 中华创伤骨科杂志, 2013, 29(1): 49-52.
9.	Sirkin M, Sanders R, DiPasquale T, et al. A staged protocol for soft tissue management in the treatment of complex pilon fractures. J Orthop Trauma, 1999, 1(2): 78-84.
10.	Calori GM, Tagliabue L, Mazza E, et al. Tibial pilon fractures: which method of treatment? Injury, 2010, 41(11): 1183-1190.
11.	赵友明, 郭晓山, 宋永焕, 等. 延期切开复位内固定加植骨治疗严重Pilon骨折. 中华创伤杂志, 2007, 23(9): 689-691.
12.	Watson JT, Karges DE, Cramer KE, et al. Analysis of failure of hybrid external fixation techniques for the treatment of distal tibial pilon fractures. The 16th Annual Meeting of the Orthopaedic Trauma Association: San Antonio, 2000.
13.	杨正明, 潘志军, 李杭, 等. 胫骨Pilon骨折的外科治疗策略. 中华创伤杂志, 2010, 26(9): 835-839.
14.	Saxena V, Hwang CW, Huang S, et al. Vacuum-assisted closure: microdeformations of wounds and cell proliferation. Plast Reconst Surg, 2004, 114(5): 1086-1096.
15.	Tarkin IS, Clare MP, Marcantonio A, et al. An update on the management of high-energy pilon fractures. Injury, 2008, 39(2): 142-154.
16.	Rouhani A, Elmi A, Akbari Aghdam H, et al. The role of fibular fixation in the treatment of tibia diaphysis distal third fractures. Orthop Traumatol Surg Res, 2012, 98(8): 868-872.
17.	Ketz J, Sanders R. Results of staged posterior fixation in the treatment of high-energy tibial pilon fractures. Fuß& Sprunggelenk, 2012, 10(1): 27-36.
18.	Zhang Q, Qiao Q, Gould LJ, et al. Study of the neural and vascular anatomy of the anterolateral thigh flap. J Plast Reconstr Aesthet Surg, 2010, 63(2): 365-371.

1. Rammelt S, Endres T, Grass R, et al. The role of external fixation in acute ankle trauma. Foot Ankle Clin, 2004, 9(3): 455-474.
2. Boraiah S, Kemp TJ, Erwteman A, et al. Outcome following open reduction and internal fixation of open pilon fractures. J Bone Joint Surg (Am), 2010, 92(2): 346-352.
3. 陈大伟, 李兵, 俞光荣. Pilon骨折的切开复位内固定治疗进展. 中华创伤骨科杂志, 2013, 15(3): 235-238.
4. Hess F, Sommer C. Minimally invasive plate osteosynthesis of the distal fibula with the locking compression plate: first experience of 20 cases. J Orthop Trauma, 2011, 25(2): 110-115.
5. 孙鸿涛, 黄枫, 周琦石, 等. 自体髂骨移植重建胫骨pilon骨折胫骨远端关节面缺损的临床疗效. 中华创伤骨科杂志, 2011, 13(7): 649-652.
6. Koshima I, Nanba Y, Tsutsui T, et al. Perforator flaps in lower extremity reconstruction. Handchir Mikrochir Plast Chir, 2002, 34(4): 251-256.
7. 俞光荣, 陈大伟, 赵宏谋, 等. 支撑钢板治疗后侧pilon骨折的疗效分析. 中华创伤杂志, 2013, 29(3): 243-246.
8. 魏世隽, 蔡贤华, 刘曦明, 等. 有限切开复位结合锁定加压接骨板内固定治疗胫骨Pilon骨折. 中华创伤骨科杂志, 2013, 29(1): 49-52.
9. Sirkin M, Sanders R, DiPasquale T, et al. A staged protocol for soft tissue management in the treatment of complex pilon fractures. J Orthop Trauma, 1999, 1(2): 78-84.
10. Calori GM, Tagliabue L, Mazza E, et al. Tibial pilon fractures: which method of treatment? Injury, 2010, 41(11): 1183-1190.
11. 赵友明, 郭晓山, 宋永焕, 等. 延期切开复位内固定加植骨治疗严重Pilon骨折. 中华创伤杂志, 2007, 23(9): 689-691.
12. Watson JT, Karges DE, Cramer KE, et al. Analysis of failure of hybrid external fixation techniques for the treatment of distal tibial pilon fractures. The 16th Annual Meeting of the Orthopaedic Trauma Association: San Antonio, 2000.
13. 杨正明, 潘志军, 李杭, 等. 胫骨Pilon骨折的外科治疗策略. 中华创伤杂志, 2010, 26(9): 835-839.
14. Saxena V, Hwang CW, Huang S, et al. Vacuum-assisted closure: microdeformations of wounds and cell proliferation. Plast Reconst Surg, 2004, 114(5): 1086-1096.
15. Tarkin IS, Clare MP, Marcantonio A, et al. An update on the management of high-energy pilon fractures. Injury, 2008, 39(2): 142-154.
16. Rouhani A, Elmi A, Akbari Aghdam H, et al. The role of fibular fixation in the treatment of tibia diaphysis distal third fractures. Orthop Traumatol Surg Res, 2012, 98(8): 868-872.
17. Ketz J, Sanders R. Results of staged posterior fixation in the treatment of high-energy tibial pilon fractures. Fuß& Sprunggelenk, 2012, 10(1): 27-36.
18. Zhang Q, Qiao Q, Gould LJ, et al. Study of the neural and vascular anatomy of the anterolateral thigh flap. J Plast Reconstr Aesthet Surg, 2010, 63(2): 365-371.

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EFFECTIVENESS OBSERVATION OF STAGED TREATMENT OF OPEN Pilon FRACTURE COMBINED WITH SOFT TISSUE DEFECT

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