Total fractures of the tibial pilon

Abstract

Complete fractures of the tibial pilon are rare and their treatment difficult. The pathophysiology includes three groups: (A) high-energy trauma (motor vehicle injuries), with severe articular and soft tissue lesions, (B) rotation trauma, (skiing accidents), with modest articular and soft tissue damage, and (C) low-energy trauma in elderly people. These three groups occasion very different problems and complications. In emergency situations, these fractures should be stabilized, most often using external fixation to restore length and prepare definitive fixation. The second stage can be applied once soft tissue healing is achieved. Two methods are discussed: internal plating and definitive external fixation. The first goal of treatment is to restore the articular surface, although this does not always prevent secondary arthritis. The second is to restore correct positioning of the foot as regard to the leg. The complication rate is high. Neither of the two fixation techniques has proven to be more effective. In group B, the two methods are similar, but external fixation seems to be safer in group A.

Hybrid External Fixation for Arbeitsgemeinschaft für Osteosynthesefragen (AO) 43-C Tibial Plafond Fractures

“…The use of external fixation for tibial plafond fractures helps to avoid dissection of the metaphyseal-diaphyseal region, minimizing iatrogenic soft tissue trauma and preserving the biology of the fracture hematoma (9,10,31). Regardless of the external fixation device used for this fracture, surgery can be performed early without compromising the soft tissue, leading to immediate reduction of the joint surface and stabilization of the fracture (9,10,(15)(16)(17)23,31). These devices are also useful in the treatment of open fractures, because soft tissue coverage over the plates and screws is lacking.…”

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

“…введение Частота тяжелых внутрисуставных перело-мов дистального метаэпифиза большеберцовой кости (ДМэБК) достигает 10% среди всех пере-ломов костей нижних конечностей [1][2][3][4].…”

“…Чаще всего переломы пилона встре-чаются у молодых трудоспособных пациентов, склонных к высокой физической активности, а нередко -и к занятиям экстремальными ви-дами спорта. при этом переломы ДМэБК име-ют высокоэнергетический характер [2,4,6,10].…”

“…этот факт, с учетом особенностей анатомии данной облас-ти, неизбежно приводит к трофическим нару-шениям мягких тканей, покрывающих зону перелома [4,[11][12][13]. С практической точки зрения интересен тот факт, что достигнутые результаты лечения коррелируют с тяжестью перелома и травмой мягких тканей, а так-же качеством хирургического лечения [2,7].…”

Pilon kırıklarında radyolojik değerlendirme ve sınıflama

“…Bunlar; Bu fragmanlar farklı büyüklüklerde, kimi olgularda parçalanmış, zaman zaman da tibia distal diafizi fragmanların arasına girmiş olabilir. [2] Pilon kırıkları için, direkt grafi görüntülerini temel alan ve yaygın olarak kullanılan iki temel sınıflandır-ma sistemi mevcuttur. Bunlar Rüedi ve Allgöwer [6] ve AO Foundation and Orthopaedic Trauma Association (AO/ OTA) sınıflamalarıdır.…”