Tibial pilon fractures treated with hybrid external fixator: analysis of 75 cases View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2019-04

AUTHORS

M. Scaglione, F. Celli, F. Casella, L. Fabbri

ABSTRACT

INTRODUCTION: The treatment of tibial pilon fractures is a surgical challenge due to the particular anatomical and vascular characteristics of this area, and the severity of the injury that can compromise soft tissues. Nowadays there is no gold-standard treatment for these fractures. MATERIALS AND METHODS: We reviewed 75 patients with tibial pilon fracture type C (AO classification) treated with hybrid external fixation (Stryker TenXor®). The surgical technique was reported. We evaluated clinical (Tornetta's score, VAS score, range of motion) and radiographic outcomes. RESULTS: In 71 cases, the first surgical treatment was definitive. Instead, in four cases, it was necessary a second surgical procedure to achieve fracture healing. We obtained 44% excellent, 40% good, 7% discrete, and 9% bad results. We found a 30% of superficial infections of the pin site, resolved with oral antibiotic treatment (amoxicillin and clavulanic acid). We never had deep infections, no neurovascular injury, and no cases of secondary amputation. Although not statistically significant, we noticed a correlation between longer recovery times and trauma severity, with slower recovery in open or grade III fractures or when associated with other fractures. CONCLUSIONS: According to the recent literature, we think that the best treatment for non-articular fracture is the internal osteosynthesis within 6 h or after 6 days from trauma. In articular fractures, the elective treatment is the two-step management. In complicated articular fractures (Tscherne > 2, open, comminuted type III) is highly indicated the external fixation combined with minimal internal synthesis. More... »

PAGES

83-89

References to SciGraph publications

  • 2002. Treatment with External Fixation in FRACTURES OF THE TIBIAL PILON
  • 2007-01. Long-term results of pilon fractures in ARCHIVES OF ORTHOPAEDIC AND TRAUMA SURGERY
  • 2015-11. Management of high-energy tibial pilon fractures in STRATEGIES IN TRAUMA AND LIMB RECONSTRUCTION
  • 2010-04. Distal tibia fractures: management and complications of 101 cases in INTERNATIONAL ORTHOPAEDICS
  • Journal

    TITLE

    MUSCULOSKELETAL SURGERY

    ISSUE

    1

    VOLUME

    103

    Author Affiliations

    Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1007/s12306-018-0550-z

    DOI

    http://dx.doi.org/10.1007/s12306-018-0550-z

    DIMENSIONS

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    PUBMED

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    32 schema:description INTRODUCTION: The treatment of tibial pilon fractures is a surgical challenge due to the particular anatomical and vascular characteristics of this area, and the severity of the injury that can compromise soft tissues. Nowadays there is no gold-standard treatment for these fractures. MATERIALS AND METHODS: We reviewed 75 patients with tibial pilon fracture type C (AO classification) treated with hybrid external fixation (Stryker TenXor®). The surgical technique was reported. We evaluated clinical (Tornetta's score, VAS score, range of motion) and radiographic outcomes. RESULTS: In 71 cases, the first surgical treatment was definitive. Instead, in four cases, it was necessary a second surgical procedure to achieve fracture healing. We obtained 44% excellent, 40% good, 7% discrete, and 9% bad results. We found a 30% of superficial infections of the pin site, resolved with oral antibiotic treatment (amoxicillin and clavulanic acid). We never had deep infections, no neurovascular injury, and no cases of secondary amputation. Although not statistically significant, we noticed a correlation between longer recovery times and trauma severity, with slower recovery in open or grade III fractures or when associated with other fractures. CONCLUSIONS: According to the recent literature, we think that the best treatment for non-articular fracture is the internal osteosynthesis within 6 h or after 6 days from trauma. In articular fractures, the elective treatment is the two-step management. In complicated articular fractures (Tscherne > 2, open, comminuted type III) is highly indicated the external fixation combined with minimal internal synthesis.
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