The treatment of Tillaux bone block in the Ruedi-Allgower type <b>Ⅲ</b> Pilon fractures _Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 WANG Lei ¹ , LIU Xin ² , WU Zhixin ¹ , LI Ligeng ¹ , HU Yongcheng ³

1. The Fourth Trauma Department of Orthopedics, the Second Hospital of Tangshan, Tangshan Hebei, 063000, P.R.China;
2. Rehabilitation Group of the Second Department of Neurosurgery, Tangshan City Workers Hospital, Tangshan Hebei, 063000, P.R.China;
3. Department of Orthopaedical Oncology, Tianjin Hospital, Tianjin, 300210, P.R.China;

Corresponding?author：

WANG Lei, Email: wanglei2003814@163.com

Keywords：

Tillaux bone block; Pilon fracture; restoration; internal fixation

DOI：

10.7507/1002-1892.201710068

Video：

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ObjectiveTo analyze the importance and effectiveness of Tillaux bone block in Ruedi-Allgower type Ⅲ of Pilon fracture surgery.MethodsTwenty-one patients with Pilon fractures with Tillaux dislocation were treated between February 2010 and September 2013. There were 17 males and 4 females, aged from 28 to 68 years with an average age of 42.9 years. The causes of injury included falling from height in 13 cases, falls injury in 4 cases, crush injury in 2 cases, and sprained injury in 2 cases. X-ray film and CT examination showed that all 21 patients had fibula fracture and Tillaux bone block had obvious displacement. According to AO/OTA classification, there were 3 cases of type C1.2, 1 case of type C1.3, 10 cases of type C2, and 7 cases of type C3. The duration from injury to operation ranged from 4 to 31 days, with an average of 10 days. All cases of Pilon fracture were treated with open reduction and plate internal fixation. Steel plate or screw was used to fixation for Tillaux block; allograft bone graft was selected for compression of fracture.ResultsThere were 2 cases of skin necrosis at the corner of wound after operation, and the wound healed after corresponding treatment; the wound healed at first intention in the other 19 cases. The effect of surgical reduction was evaluated by Burwell-Chamley imaging scoring system within 72 hours after operation, there were 19 cases of anatomical reduction and 2 cases of general reduction. All the 21 patients were followed up 18-48 months, with an average of 24.9 months. No complication such as nerve injury, loosening of internal fixation, or periprosthetic fracture was found during follow-up. All fractures obtained bone healing, which lasted from 4 to 8 months, with an average of 6 months. The ankle and hindfoot scores of the American Orthopaedic Foot and Ankle Society (AOFAS) were used to evaluate the ankle and hindfoot function at 1 year after operation or at last follow-up, the results were excellent in 13 cases, good in 6 cases, and fair in 2 cases, with an excellent and good rate of 90.5%. Internal fixator was removed from 19 patients at 15-19 months after operation. There were 17 cases of joint hyperplasia and 4 cases of osteoarthritis. All joint mobility was restored. The functional recovery of the ankle joint was evaluated according to the Olerud-Molander ankle fracture score standard, the results were good in 6 cases, fair in 8 cases, and poor in 7 cases at postoperative full weight training; and after 1 year of full weight training, the results were excellent in 10 cases, good in 3 cases, fair in 6 cases, and poor in 2 cases.ConclusionThe Tillaux bone block is a reliable marker for the reduction of complex Pilon fractures. The reconstruction of the Tillaux can improve the effectiveness of complex Pilon fractures.

Citation： WANG Lei, LIU Xin, WU Zhixin, LI Ligeng, HU Yongcheng. The treatment of Tillaux bone block in the Ruedi-Allgower type Ⅲ Pilon fractures . Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(10): 1308-1312. doi: 10.7507/1002-1892.201710068 Copy

1.	榮國威, 王承武. 骨折. 北京: 人民衛生出版社, 2007: 1184.
2.	胥少汀, 葛寶豐, 徐印坎. 實用骨科學. 3 版. 北京: 人民軍醫出版社, 2006: 796.
3.	張世民, 李海豐, 黃軼剛. 骨折分類與功能評定. 北京: 人民軍醫出版社, 2008: 198.
4.	Wynes J, Kirksey L. Assessing vascular status and risk of latent ischemia with ankle fracture: a case report and algorithm for treatment. J Foot Ankle Surg, 2014, 53(3): 353-355.
5.	Rammelt S, Marti RK, Zwipp H. Joint-preserving osteotomy of malunited ankle and Pilon fractures. Unfallchirurg, 2013, 116(9): 789-796.
6.	Tornetta P 3rd, Qadir R, Sanders R. Pain dominates summed scores for hindfoot and ankle trauma. J Orthop Trauma, 2013, 27(8): 477-482.
7.	南登崑. 康復醫學. 4 版. 北京: 人民衛生出版社, 2008: 52.
8.	Burwell HN, Charnley AD. The treatment of displaced fractures at the ankle by rigid internal fixation and early joint movement. J Bone Joint Surg (Br), 1965, 47(4): 634-660.
9.	Olerud C, Molander H. A scoring scale for symptom evaluation after ankle fracture. Arch Orthop Trauma Surg, 1984, 103(3): 190-194.
10.	Kumar N, Prasad M. Tillaux fracture of the ankle in an adult: a rare injury. J Foot Ankle Surg, 2014, 53(6): 757-758.
11.	Oak NR, Sabb BJ, Kadakia AR, et al. Isolated adult Tillaux fracture: a report of two cases. J Foot Ankle Surg, 2014, 53(4): 489-492.
12.	Sharma B, Reddy IS, Meanock C. The adult Tillaux fracture: one not to miss. BMJ Case Rep, 2013.
13.	Wuerz TH, Gurd DP. Pediatric physeal ankle fracture. J Am Acad Orthop Surg, 2013, 21(4): 234-244.
14.	Rosenbaum AJ, DiPreta JA, Uhl RL. Review of distal tibial epiphyseal transitional fractures. Orthopedics, 2012, 35(12): 1046-1049.
15.	Sprenger De Rover WB, Alazzawi S, Hallam PJ, et al. Ipsilateral tibial shaft fracture and distal tibial triplane fracture with an intact fibula: a case report. J Orthop Surg (Hong Kong), 2011, 19(3): 364-366.
16.	Waryasz GR, Bariteau JT. Trichophyton rubrum osteomyelitis after calcaneus external fixation pin stabilization of a Pilon fracture. J Foot Ankle Surg, 2014, 53(4): 480-484.
17.	Lidder S, Masterson S, Dreu M, et al. The risk of injury to the peroneal artery in the posterolateral approach to the distal tibia: a cadaver study. J Orthop Trauma, 2014, 28(9): 534-537.
18.	Thomason K, Ramesh A, McGoldrick N, et al. Primary ankle arthrodesis for neglected open Weber B ankle fracture dislocation. J Foot Ankle Surg, 2014, 53(4): 446-448.
19.	Crawford AH. Triplane and Tillaux fractures: is a 2 mm residual gap acceptable? J Pediatr Orthop, 2012, 32(Suppl 1): S69-73.
20.	Obrink-Hansen K, Borris LC. Tillaux fracture and fracture of the lateral malleolus with no medial soreness. Ugeskr Laeger, 2011, 173(34): 2049-2050.
21.	Gourineni P, Gupta A. Medial joint space widening of the ankle in displaced Tillaux and Triplane fractures in children. J Orthop Trauma, 2011, 25(10): 608-611.
22.	Di Giorgio L, Touloupakis G, Theodorakis E, et al. A two-choice strategy through a medial tibial approach for the treatment of Pilon fractures with posterior or anterior fragmentation. Chin J Traumatol, 2013, 16(5): 272-276.
23.	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.
24.	Choudhry IK, Wall EJ, Eismann EA, et al. Functional outcome analysis of triplane and Tillaux fractures after closed reduction and percutaneous fixation. J Pediatr Orthop, 2014, 34(2): 139-143.
25.	Liporace FA, Yoon RS, Kubiak EN, et al. Does adding computed tomography change the diagnosis and treatment of Tillaux and triplane pediatric ankle fractures? Orthopedics, 2012, 35(2): e208-212.

1. 榮國威, 王承武. 骨折. 北京: 人民衛生出版社, 2007: 1184.
2. 胥少汀, 葛寶豐, 徐印坎. 實用骨科學. 3 版. 北京: 人民軍醫出版社, 2006: 796.
3. 張世民, 李海豐, 黃軼剛. 骨折分類與功能評定. 北京: 人民軍醫出版社, 2008: 198.
4. Wynes J, Kirksey L. Assessing vascular status and risk of latent ischemia with ankle fracture: a case report and algorithm for treatment. J Foot Ankle Surg, 2014, 53(3): 353-355.
5. Rammelt S, Marti RK, Zwipp H. Joint-preserving osteotomy of malunited ankle and Pilon fractures. Unfallchirurg, 2013, 116(9): 789-796.
6. Tornetta P 3rd, Qadir R, Sanders R. Pain dominates summed scores for hindfoot and ankle trauma. J Orthop Trauma, 2013, 27(8): 477-482.
7. 南登崑. 康復醫學. 4 版. 北京: 人民衛生出版社, 2008: 52.
8. Burwell HN, Charnley AD. The treatment of displaced fractures at the ankle by rigid internal fixation and early joint movement. J Bone Joint Surg (Br), 1965, 47(4): 634-660.
9. Olerud C, Molander H. A scoring scale for symptom evaluation after ankle fracture. Arch Orthop Trauma Surg, 1984, 103(3): 190-194.
10. Kumar N, Prasad M. Tillaux fracture of the ankle in an adult: a rare injury. J Foot Ankle Surg, 2014, 53(6): 757-758.
11. Oak NR, Sabb BJ, Kadakia AR, et al. Isolated adult Tillaux fracture: a report of two cases. J Foot Ankle Surg, 2014, 53(4): 489-492.
12. Sharma B, Reddy IS, Meanock C. The adult Tillaux fracture: one not to miss. BMJ Case Rep, 2013.
13. Wuerz TH, Gurd DP. Pediatric physeal ankle fracture. J Am Acad Orthop Surg, 2013, 21(4): 234-244.
14. Rosenbaum AJ, DiPreta JA, Uhl RL. Review of distal tibial epiphyseal transitional fractures. Orthopedics, 2012, 35(12): 1046-1049.
15. Sprenger De Rover WB, Alazzawi S, Hallam PJ, et al. Ipsilateral tibial shaft fracture and distal tibial triplane fracture with an intact fibula: a case report. J Orthop Surg (Hong Kong), 2011, 19(3): 364-366.
16. Waryasz GR, Bariteau JT. Trichophyton rubrum osteomyelitis after calcaneus external fixation pin stabilization of a Pilon fracture. J Foot Ankle Surg, 2014, 53(4): 480-484.
17. Lidder S, Masterson S, Dreu M, et al. The risk of injury to the peroneal artery in the posterolateral approach to the distal tibia: a cadaver study. J Orthop Trauma, 2014, 28(9): 534-537.
18. Thomason K, Ramesh A, McGoldrick N, et al. Primary ankle arthrodesis for neglected open Weber B ankle fracture dislocation. J Foot Ankle Surg, 2014, 53(4): 446-448.
19. Crawford AH. Triplane and Tillaux fractures: is a 2 mm residual gap acceptable? J Pediatr Orthop, 2012, 32(Suppl 1): S69-73.
20. Obrink-Hansen K, Borris LC. Tillaux fracture and fracture of the lateral malleolus with no medial soreness. Ugeskr Laeger, 2011, 173(34): 2049-2050.
21. Gourineni P, Gupta A. Medial joint space widening of the ankle in displaced Tillaux and Triplane fractures in children. J Orthop Trauma, 2011, 25(10): 608-611.
22. Di Giorgio L, Touloupakis G, Theodorakis E, et al. A two-choice strategy through a medial tibial approach for the treatment of Pilon fractures with posterior or anterior fragmentation. Chin J Traumatol, 2013, 16(5): 272-276.
23. 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.
24. Choudhry IK, Wall EJ, Eismann EA, et al. Functional outcome analysis of triplane and Tillaux fractures after closed reduction and percutaneous fixation. J Pediatr Orthop, 2014, 34(2): 139-143.
25. Liporace FA, Yoon RS, Kubiak EN, et al. Does adding computed tomography change the diagnosis and treatment of Tillaux and triplane pediatric ankle fractures? Orthopedics, 2012, 35(2): e208-212.

Chinese Journal of Reparative and Reconstructive Surgery

The treatment of Tillaux bone block in the Ruedi-Allgower type Ⅲ Pilon fractures

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