Comparative Analysis of Treatment Outcomes in Patients With Types B and C Pylon Fractures

Abstract

Objective — to develop and implement improved approaches to the diagnosis and tactics of surgical treatment in patients with fractures of the distal tibia metaepiphysis.Material and methods. The study included 126 patients with fractures of distal tibia metaepiphysis of «B» and «C» types who underwent internal fixation with plates in 2005–2012. The authors analyzed surgical treatment outcomes within the period from 2.5 to 9 years (average of 5.7–2.3 years) of postoperative follow up. Average age of patients was 23.4±2.1 years. Patients were divided into the main group (64 patients) and the comparison group (62 patients). In the comparison group, traditional approaches to diagnosis and surgical treatment were used, including standard clinical examination and X-rays of the affected ankle in two views and the median access to the distal tibia metaepiphysis. In the main group, a specially elaborated algorithm for selection of optimal surgical tactics was utilized basing on the improved diagnostics program. Clinical and functional data were assessed by Foot and Ankle Outcome Score (FAOS) and SF-36 Health Survey. Roentgenological assessment was done by X-rays and CT scans. Statistical significance of the differences was evaluated by Wald-Wolfowitz and Fisher tests.Results. Improved approaches to the tactics of surgical treatment in patients with pylon fractures of «B» and «C» types allowed to reduce the incidence of unsatisfactory anatomical and functional outcomes from 43.5% to 28.1%. The number of satisfactory and good outcomes increased by 4.7% and 10.7% respectively after application of improved therapeutic and diagnostic approaches.Conclusion. Proposed improved approaches to verification of severe intraarticular fractures of the distal tibia metabiphysis allowed to increase the informative value of the diagnostic procedures and to avoid discrepancies between preand intraoperative assessment of fracture type by classifications of M. Mueller-AS (1989) and X. Tang, P. Tang (2012) as well as to avoid diagnostic errors in detecting the facet impression of the distal tibia metaepiphysis.

The analysis of late postoperative foot functions in patients with post-traumatic ankle arthrosis

“…The problem of managing patients with the consequences of intra-articular injuries of distal tibia and/or fibula remains relevant due to their high prevalence and incidence, frequent poor outcomes and disability [1,2]. This is also caused by the variety of surgical techniques including those joint-preserving (corrective osteotomy of the distal fibula and tibia followed by osteosynthesis, arthroscopic interventions, or distraction arthroplasty) and not jointpreserving (arthrodesis or total arthroplasty) [3,4]. Restrictions on the foot functioning in the late postoperative period depend, among other things, on the type of surgical intervention performed on the patient [5].…”