Comparison Between the Modified External Fixation and Calcaneal Traction in Ruedi-Allgower Type II/III Pilon Fractures

Abstract

Background To compare the effect of modified external fixation and calcaneal traction in a staged management of Ruedi-Allgower type II/III tibial pilon fractures. Material/Methods The data of 62 patients with Ruedi-Allgower type II/III tibial pilon fractures who were treated in Liuzhou People’s hospital from January 2017 to December 2018 were extracted in this retrospective analysis. There were 32 patients in the temporary external fixation (TEF) group and 30 patients in calcaneal traction (CT) group. Outcomes, including the duration of the surgical procedure, pin track infection, degree of limb swelling, time to second-stage operation, postoperative comfort score, and visual analog scale (VAS) score, were compared. Results The effective rate of swelling reduction after treatment was 85% in the TEF group and 60% in the CT group; the average time to the second-stage operation was 8.34±1.29 days in the TEF group and 10.60±2.27 days in the CT group; the postoperative comfort scores were 70.1±3.2 and 61.3±3.5 in the TEF group and CT group, respectively; the postoperative VAS scores at 24 h, 48 h, and 7 days were 7.90±1.06, 4.88±0.83, 2.72±1.14 in TEF group, and 8.50±0.86, 6.27±1.36, 3.57±1.19 in CT group, respectively. There were 1 case of pin tract infection identified in the TEF group and 4 in the CT group. All differences were statistically significant (P<0.05). Conclusions The modified external fixation is more effective than calcaneal traction in treatment of Ruedi-Allgower type II/III tibial pilon fractures in the first-stage of combined management.

Utility of 2.0 mm diameter Kirschner wires assembled with Wu’s Tension Traction Bows in calcaneal skeletal traction

“…However, our study has already showed that no significant differences were found either 2.0 mm diameter Kirschner wires or 3.5 mm diameter Steinmann pins used, in terms of traction weight, effectiveness of swelling reduction, length of preoperative traction duration and pain relief, but lower incidence and shorter duration of post-traction bleeding, as well as faster wounds healing, were definitely observed with the use of thinner traction pins. Given our study’s validation of the safety and efficacy of 2.0 mm diameter Kirschner wires for skeletal traction, and considering the elevated rates of pin tract infections reported with larger diameter traction pins in other studies 3 , 13 , in which 4.0 mm or lager diameter traction pins were used 3 , 13 , we advocate for the use of 2.0 mm diameter Kirschner wires in skeletal traction procedures.…”

“…Several studies have demonstrated that these management techniques can significantly enhance patients' prognosis 4 , 6 – 12 . While previous studies have predominantly focused on evaluating the clinical impact of preoperative temporary external fixation, limited research has directly compared the effectiveness of skin traction, skeletal traction, and external fixation 3 , 4 , 13 , 14 . Moreover, studies examining the differences in efficacy among different diameter traction pins in skeletal traction are scarce.…”

“…The severity of limb swelling was divided into 4 grades 3 . Degree 1: no obvious swelling and no abnormal changes compared to the normal limb; Degree 2: regional skin gets tighter than normal part, but dermatoglyph is still present.…”

“…On such basis, Swelling reduction was then assessed according to the time consumed from the date of traction implementation to the time when limb swelling reached Degree 2. Detailed criteria 3 are as follows: (1) Markedly effective: < 3 days; (2) Effective: 3–6 days; (3) Fair: > 6 days. Both effective and markedly effective cases were used to calculate the overall effective rate.…”

Comparison of temporary external and percutaneous k-wire fixations for treatment of ankle fracture–dislocations

“…Several techniques have been introduced for the initial treatment of severe fractures, such as external xator xation, splint xation, and calcaneal traction. Typically, these techniques have been applied to complex tibial plateau fractures, pilon fractures, and other severe injuries [17][18][19][20]. A paradigm shift has been achieved by adding ankle fracture-dislocations to the indications for two-stage management.…”