POSTEROLATERAL AND POSTEROMEDIAL APPROACHES FOR TREATMENT OF POSTERIOR Pilon FRACTURES IN ELDERLY PATIENTS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHENJuwen ¹ , WANGYongqing ¹ ,  KONGLingwei ² , LIBaogui ¹ , ZHAOZhihui ¹

1. Department of Orthopaedics, the Fourth Central Clinical College, Tianjin Medical University, Tianjin, 300140, P. R. China;
2. Department ofHand Surgery, the Third Clinical College, Hebei Medical University;

Corresponding?author：

KONGLingwei, Email: klw380@sohu.com

Keywords：

Posterior Pilon fracture; Ankle; Internal fixation; Elderly patient

DOI：

10.7507/1002-1892.20160222

Video：

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Objective To explore the clinical outcomes of open reduction and internal fixation by posterolateral and posteromedial approaches for treating posterior Pilon fractures in elderly patients. Methods Between August 2009 and August 2014, 20 elderly patients with posterior Pilon fractures were treated with open reduction and internal fixation by posterolateral and posteromedial approaches. There were 14 males and 6 females, aged from 66 to 83 years (mean, 72.7 years). The causes were falling injury in 11 cases and traffic accident injury in 9 cases. All the patients had lateral malleolus and medial malleolus fractures. The time from injury to operation was 7-14 days (mean, 8.6 days). The posterolateral incision was made to expose the posterolateral bone fragments of posterior malleolus and lateral malleolus fracture, and the posteromedial incision was made to expose the posteromedial fracture fragments of posterior malleolus and medial malleolus fracture. After reduction, fracture was fixed with locking plate or cannulated screw. All the patients began to functional exercise at 1 day after operation. Results The operation time was 60-110 minutes (mean, 92 minutes). The incisions healed primarily in all patients. There were no complications of incision dehiscence, infection, implant exposure, and nerve damage. No irritation sign of tendon was observed. All 20 cases were followed up for 12-18 months (mean, 13 months). The X-ray films showed that fracture healed at 3-9 months, with an average of 5.2 months. During follow-up period, no loosening or breakage of the implant was observed. The other patients could walk normally except 2 patients (over 80 years old) who could walk with crutch. According to American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, the results were excellent in 12 cases, good in 4 cases, and fair in 4 cases; the excellent and good rate was 80%. Conclusion A combination of posterolateral approach and posteromedial approach for open reduction and fixation of posterior Pilon fractures can achieve satisfactory effect in elderly patients. It has the advantages of protecting ankle blood supply and avoiding the soft tissue necrosis and implants exposure.

Citation： CHENJuwen, WANGYongqing, KONGLingwei, LIBaogui, ZHAOZhihui. POSTEROLATERAL AND POSTEROMEDIAL APPROACHES FOR TREATMENT OF POSTERIOR Pilon FRACTURES IN ELDERLY PATIENTS. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(9): 1089-1093. doi: 10.7507/1002-1892.20160222 Copy

1.	?陳志偉, 陳丹, 陽海清, 等.雙切口聯合入路360°內固定治療高能量閉合性Pilon骨折.中國修復重建外科雜志, 2015, 29(10):1226-1229.
2.	肖睿, 唐強, 蔡程, 等.有限內固定結合外固定支架治療Pilon骨折.中國修復重建外科雜志, 2005, 19(8):603-606.
3.	Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 1994, 15(7):349-353.
4.	張英澤.老年髖部骨折--中國骨科醫師面臨的機遇和挑戰.中華創傷雜志, 2014, 30(3):193-195.
5.	馬信龍.認識、重視骨質疏松癥, 提高骨質疏松性骨折的診療水平.中華骨科雜志, 2014, 34(1):1-5.
6.	Chen DW, Li B, Aubeeluck A, et al. Open reduction and internal fixation of posterior Pilon fractures with buttress plate. Acta Ortop Bras, 2014, 22(1):48-53.
7.	Haraguchi N, Haruyama H, Toga H, et al. Pathoanatomy of posterior malleolar fractures of the ankle. J Bone Joint Surg (Am), 2006, 88(5):1085-1092.
8.	魏世雋, 蔡賢華, 劉曦明, 等.后內側入路低切跡多向鎖定接骨板內固定治療累及內踝的脛骨后Pilon骨折.中國修復重建外科雜志, 2014, 28(5):558-561.
9.	趙宏謀, 梁曉軍, 李毅, 等.脛骨遠端內外翻畸形對脛距關節接觸的影響.中國修復重建外科雜志, 2016, 30(7):826-829.
10.	魏世雋, 蔡賢華, 劉曦明, 等.有限切開復位結合鎖定加壓接骨板內固定治療脛骨Pilon骨折.中華創傷雜志, 2013, 29(1):49-52.
11.	Tang X, Tang PF, Wang MY, et al. Pilon fractures:a new classification and therapeutic strategies. Chin Med J (Engl), 2012, 125(14):2487-2492.
12.	俞光榮, 陳大偉, 趙宏謀, 等.支撐鋼板固定后側Pilon骨折的療效分析.中華創傷雜志, 2013, 29(3):243-248.
13.	Klammer G, Kadakia AR, Joos DA, et al. Posterior Pilon fractures:a retrospective case series and proposed classification system. Foot Ankle Int, 2013, 34(2):189-199.
14.	魏世雋, 蔡賢華, 黃繼鋒, 等.內外翻不同損傷機制導致脛骨Pilon骨折的手術策略.中華骨科雜志, 2014, 34(3):298-305.
15.	陳雁西, 俞關榮.踝關節骨折的治療策略與數字化臨床路徑.中華骨科雜志, 2011, 31(3):275-284.
16.	王小平, 韋展圖, 黃儉, 等.虛擬三維重建術前規劃技術在Pilon骨折的應用研究.中國修復重建外科雜志, 2016, 30(1):44-49.
17.	東靖明, 田旭, 馬寶通.經踝關節后外側入路治療三踝骨折.中華創傷雜志, 2013, 29(6):536-540.
18.	李延煒, 洪海森, 劉暉, 等. TightRope治療下脛腓聯合分離的近期療效.中國修復重建外科雜志, 2016, 30(8):971-974.
19.	劉建永.腓骨側單隧道解剖重建與改良Brostrom法縫合修復治療慢性踝關節外側不穩定的對比研究.中國修復重建外科雜志, 2015, 29(10):1214-1220.

1. ?陳志偉, 陳丹, 陽海清, 等.雙切口聯合入路360°內固定治療高能量閉合性Pilon骨折.中國修復重建外科雜志, 2015, 29(10):1226-1229.
2. 肖睿, 唐強, 蔡程, 等.有限內固定結合外固定支架治療Pilon骨折.中國修復重建外科雜志, 2005, 19(8):603-606.
3. Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 1994, 15(7):349-353.
4. 張英澤.老年髖部骨折--中國骨科醫師面臨的機遇和挑戰.中華創傷雜志, 2014, 30(3):193-195.
5. 馬信龍.認識、重視骨質疏松癥, 提高骨質疏松性骨折的診療水平.中華骨科雜志, 2014, 34(1):1-5.
6. Chen DW, Li B, Aubeeluck A, et al. Open reduction and internal fixation of posterior Pilon fractures with buttress plate. Acta Ortop Bras, 2014, 22(1):48-53.
7. Haraguchi N, Haruyama H, Toga H, et al. Pathoanatomy of posterior malleolar fractures of the ankle. J Bone Joint Surg (Am), 2006, 88(5):1085-1092.
8. 魏世雋, 蔡賢華, 劉曦明, 等.后內側入路低切跡多向鎖定接骨板內固定治療累及內踝的脛骨后Pilon骨折.中國修復重建外科雜志, 2014, 28(5):558-561.
9. 趙宏謀, 梁曉軍, 李毅, 等.脛骨遠端內外翻畸形對脛距關節接觸的影響.中國修復重建外科雜志, 2016, 30(7):826-829.
10. 魏世雋, 蔡賢華, 劉曦明, 等.有限切開復位結合鎖定加壓接骨板內固定治療脛骨Pilon骨折.中華創傷雜志, 2013, 29(1):49-52.
11. Tang X, Tang PF, Wang MY, et al. Pilon fractures:a new classification and therapeutic strategies. Chin Med J (Engl), 2012, 125(14):2487-2492.
12. 俞光榮, 陳大偉, 趙宏謀, 等.支撐鋼板固定后側Pilon骨折的療效分析.中華創傷雜志, 2013, 29(3):243-248.
13. Klammer G, Kadakia AR, Joos DA, et al. Posterior Pilon fractures:a retrospective case series and proposed classification system. Foot Ankle Int, 2013, 34(2):189-199.
14. 魏世雋, 蔡賢華, 黃繼鋒, 等.內外翻不同損傷機制導致脛骨Pilon骨折的手術策略.中華骨科雜志, 2014, 34(3):298-305.
15. 陳雁西, 俞關榮.踝關節骨折的治療策略與數字化臨床路徑.中華骨科雜志, 2011, 31(3):275-284.
16. 王小平, 韋展圖, 黃儉, 等.虛擬三維重建術前規劃技術在Pilon骨折的應用研究.中國修復重建外科雜志, 2016, 30(1):44-49.
17. 東靖明, 田旭, 馬寶通.經踝關節后外側入路治療三踝骨折.中華創傷雜志, 2013, 29(6):536-540.
18. 李延煒, 洪海森, 劉暉, 等. TightRope治療下脛腓聯合分離的近期療效.中國修復重建外科雜志, 2016, 30(8):971-974.
19. 劉建永.腓骨側單隧道解剖重建與改良Brostrom法縫合修復治療慢性踝關節外側不穩定的對比研究.中國修復重建外科雜志, 2015, 29(10):1214-1220.

Chinese Journal of Reparative and Reconstructive Surgery

POSTEROLATERAL AND POSTEROMEDIAL APPROACHES FOR TREATMENT OF POSTERIOR Pilon FRACTURES IN ELDERLY PATIENTS

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