Clinical application of nose ring drain technique combined with Ilizarov circular external fixation for Gustilo ⅢA Pilon fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

PU Shaoquan ¹ , XU Yongqing ¹ , Lü Qian ¹ , LIU Zhineng ² , ZHAO Yonghui ¹ , ZHAO Zeyu ¹ , XIA Shen ¹ , QI Xin ¹ , QU Long ³ ,  ZHU Yueliang ¹

1. Department of Orthopaedics, the 920th Hospital of Joint Logistics Support Force, Kunming Yunnan, 650032, P.R.China;
2. Department of Orthopedics, People’s Hospital of Dongchuan District of Kunming, Kunming Yunnan, 654100, P.R.China;
3. Department of Orthopedics, Aerospace 731 Hospital, Beijing, 100074, P.R.China;

Corresponding?author：

ZHU Yueliang, Email: 416197429@qq.com

Keywords：

Pilon fracture; Gustilo Ⅲ A fracture; nose ring drain technique; Ilizarov technique; circular external fixation

DOI：

10.7507/1002-1892.202009101

Video：

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Objective To investigate the effectiveness of the nose ring drain (NRD) technique combined with Ilizarov circular external fixation in treatment of Gustilo ⅢA Pilon fracture.Methods Between March 2017 and December 2019, 17 patients with Gustilo ⅢA Pilon fractures were admitted and treated with NRD technique combined with Ilizarov circular external fixation. Among them, there were 11 males and 6 females; the age ranged from 24 to 63 years, with an average of 38.2 years. There were 3 cases of traffic accident injury, 13 cases of falling injury, and 1 case of penetrating injury. There were 13 cases of emergency admittance and 4 cases of wound infection after surgical treatment. Furthermore, there were 2 cases of fibula fractures and 3 cases of lateral malleolus fractures. Results All patients were followed up 8-12 months, with an average of 9.9 months. All wounds healed by first intention, and 4 patients with preoperative infection had no recurrence during the follow-up. The external fixator was removed after fracture healing in 17 patients at 3-7 months after operation (mean, 4.5 months). At last follow-up, the pain score of the ankle joint Kofoe score was 40-50, with an average of 44; the functional score was 17-27, with an average of 25; the mobility score was 8-18, with an average of 14; and the effectiveness was rated as excellent in 8 cases, good in 7 cases, and poor in 1 case.Conclusion For Gustilo ⅢA Pilon fractures, the NRD technique combined with Ilizarov circular external fixation has advantages of good fracture fixation and drainage effects, which greatly reduces the complications of traditional treatment options and the number of operations.

Citation： PU Shaoquan, XU Yongqing, Lü Qian, LIU Zhineng, ZHAO Yonghui, ZHAO Zeyu, XIA Shen, QI Xin, QU Long, ZHU Yueliang. Clinical application of nose ring drain technique combined with Ilizarov circular external fixation for Gustilo ⅢA Pilon fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(2): 195-199. doi: 10.7507/1002-1892.202009101 Copy

1.	Rammelt S, Endres T, Grass R, et al. The role of external fixation in acute ankle trauma. Foot Ankle Clin, 2004, 9(3): 455-474.
2.	Boraiah S, Kemp TJ, Erwteman A, et al. Outcome following open reduction and internal fixation of open pilon fractures. J Bone Joint Surg (Am), 2010, 92(2): 346-352.
3.	田林, 艾克拜爾·亞森, 譚玉忠, 等. 牛鼻子引流術在嚴重糖尿病足感染創面中的臨床應用. 中國修復重建外科雜志, 2020, 34(8): 990-993.
4.	Solomin LN. Ilizarov 技術基本原理與應用. 2 版. 北京: 人民軍醫出版社, 2019: 81-85.
5.	McCann PA, Jackson M, Mitchell ST, et al. Complications of definitive open reduction and internal fixation of pilon fractures of the distal tibia. Int Orthop, 2011, 35(3): 413-418.
6.	Pollak AN, McCarthy ML, Bess RS, et al. Outcomes after treatment of high-energy tibial plafond fractures. J Bone Joint Surg (Am), 2003, 85(10): 1893-1900.
7.	Mehta S, Gardner MJ, Barei DP, et al. Reduction strategies through the anterolateral exposure for fixation of type B and C pilon fractures. J Orthop Trauma, 2011, 25(2): 116-122.
8.	Mafi P, Stanley J, Hindocha S, et al. Pilon fracture: a case report of a 45-year-old dental technician. Open Orthop J, 2014, 8: 433-436.
9.	李毅, 王虎, 梁曉軍, 等. 分期手術治療嚴重開放性踝關節骨折的療效觀察. 中國骨與關節損傷雜志, 2014, 29(2): 189-190.
10.	Huebner EJ, Iblher N, Kubosch DC, et al. Distal tibial fractures and pilon fractures. Acta Chir Orthop Traumatol Cech, 2014, 81(3): 167-176.
11.	Stillhard PF, Frima H, Sommer C. Pilon fractures-considerations for treatment strategies and surgical approaches. Oper Orthop Traumatol, 2018, 30(6): 435-456.
12.	齊欣, 徐永清, 夏燊, 等. 單純 Ilizarov 環形外固定技術治療合并骨筋膜室綜合征的脛骨平臺骨折. 中國修復重建外科雜志, 2020, 34(10): 1248-1252.
13.	閆秀中, 王燕, 王德志, 等. Ilizarov 環形外固定架治療脛腓骨開放骨折的臨床研究. 中國矯形外科雜志, 2017, 25(4): 321-324.
14.	馬赫, 姚輝, 張濤, 等. Taylor 空間外固定架與單臂外固定架治療脛腓骨開放骨折療效比較. 中國修復重建外科雜志, 2020, 34(4): 447-451.
15.	Walter G, Kemmerer M, Kappler C, et al. Treatment algorithms for chronic osteomyelitis. Dtsch Arztebl Int, 2012, 109(14): 257-264.
16.	El-Sayed M, Atef A. Management of simple (types A and B) closed tibial shaft fractures using percutaneous lag-screw fixation and Ilizarov external fixation in adults. Int Orthop, 2012, 36(10): 2133-2138.
17.	Scherer SS, Pietramaggiori G, Mathews JC, et al. The mechanism of action of the vacuum-assisted closure device. Plast Reconstr Surg, 2008, 122(3): 786-797.
18.	Morykwas MJ, Simpson J, Punger K, et al. Vacuum-assisted closure: state of basic research and physiologic foundation. Plast Reconstr Surg, 2006, 117(7 Suppl): 121S-126S.
19.	王瑞國, 荊兆峰, 邵明偉. 持續沖洗 VSD 一期閉合創腔與單純 VSD 治療軟組織壞死及感染的療效比較. 中國骨與關節損傷雜志, 2016, 31(1): 100-101.
20.	宋健, 喻愛喜, 漆白文, 等. 負壓封閉引流技術在難治性潰瘍創面的應用. 中華顯微外科雜志, 2016, 39(1): 102-104.
21.	曲龍. 骨搬移治療骨缺損與骨不連—Ilizarov 技術的臨床應用. 北京: 人民衛生出版社, 2009: 44-48.

1. Rammelt S, Endres T, Grass R, et al. The role of external fixation in acute ankle trauma. Foot Ankle Clin, 2004, 9(3): 455-474.
2. Boraiah S, Kemp TJ, Erwteman A, et al. Outcome following open reduction and internal fixation of open pilon fractures. J Bone Joint Surg (Am), 2010, 92(2): 346-352.
3. 田林, 艾克拜爾·亞森, 譚玉忠, 等. 牛鼻子引流術在嚴重糖尿病足感染創面中的臨床應用. 中國修復重建外科雜志, 2020, 34(8): 990-993.
4. Solomin LN. Ilizarov 技術基本原理與應用. 2 版. 北京: 人民軍醫出版社, 2019: 81-85.
5. McCann PA, Jackson M, Mitchell ST, et al. Complications of definitive open reduction and internal fixation of pilon fractures of the distal tibia. Int Orthop, 2011, 35(3): 413-418.
6. Pollak AN, McCarthy ML, Bess RS, et al. Outcomes after treatment of high-energy tibial plafond fractures. J Bone Joint Surg (Am), 2003, 85(10): 1893-1900.
7. Mehta S, Gardner MJ, Barei DP, et al. Reduction strategies through the anterolateral exposure for fixation of type B and C pilon fractures. J Orthop Trauma, 2011, 25(2): 116-122.
8. Mafi P, Stanley J, Hindocha S, et al. Pilon fracture: a case report of a 45-year-old dental technician. Open Orthop J, 2014, 8: 433-436.
9. 李毅, 王虎, 梁曉軍, 等. 分期手術治療嚴重開放性踝關節骨折的療效觀察. 中國骨與關節損傷雜志, 2014, 29(2): 189-190.
10. Huebner EJ, Iblher N, Kubosch DC, et al. Distal tibial fractures and pilon fractures. Acta Chir Orthop Traumatol Cech, 2014, 81(3): 167-176.
11. Stillhard PF, Frima H, Sommer C. Pilon fractures-considerations for treatment strategies and surgical approaches. Oper Orthop Traumatol, 2018, 30(6): 435-456.
12. 齊欣, 徐永清, 夏燊, 等. 單純 Ilizarov 環形外固定技術治療合并骨筋膜室綜合征的脛骨平臺骨折. 中國修復重建外科雜志, 2020, 34(10): 1248-1252.
13. 閆秀中, 王燕, 王德志, 等. Ilizarov 環形外固定架治療脛腓骨開放骨折的臨床研究. 中國矯形外科雜志, 2017, 25(4): 321-324.
14. 馬赫, 姚輝, 張濤, 等. Taylor 空間外固定架與單臂外固定架治療脛腓骨開放骨折療效比較. 中國修復重建外科雜志, 2020, 34(4): 447-451.
15. Walter G, Kemmerer M, Kappler C, et al. Treatment algorithms for chronic osteomyelitis. Dtsch Arztebl Int, 2012, 109(14): 257-264.
16. El-Sayed M, Atef A. Management of simple (types A and B) closed tibial shaft fractures using percutaneous lag-screw fixation and Ilizarov external fixation in adults. Int Orthop, 2012, 36(10): 2133-2138.
17. Scherer SS, Pietramaggiori G, Mathews JC, et al. The mechanism of action of the vacuum-assisted closure device. Plast Reconstr Surg, 2008, 122(3): 786-797.
18. Morykwas MJ, Simpson J, Punger K, et al. Vacuum-assisted closure: state of basic research and physiologic foundation. Plast Reconstr Surg, 2006, 117(7 Suppl): 121S-126S.
19. 王瑞國, 荊兆峰, 邵明偉. 持續沖洗 VSD 一期閉合創腔與單純 VSD 治療軟組織壞死及感染的療效比較. 中國骨與關節損傷雜志, 2016, 31(1): 100-101.
20. 宋健, 喻愛喜, 漆白文, 等. 負壓封閉引流技術在難治性潰瘍創面的應用. 中華顯微外科雜志, 2016, 39(1): 102-104.
21. 曲龍. 骨搬移治療骨缺損與骨不連—Ilizarov 技術的臨床應用. 北京: 人民衛生出版社, 2009: 44-48.

Chinese Journal of Reparative and Reconstructive Surgery

Clinical application of nose ring drain technique combined with Ilizarov circular external fixation for Gustilo ⅢA Pilon fractures

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