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Morphological study of CT image of posterior pilon variant fracture and its possible clinical significance

  • Orthopaedic Surgery
  • Published:
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Abstract

Objective

The incidence of posterior pilon variant fractures has been underestimated. The purpose was to study the characteristics of posteromedial (PM) and posterolateral (PL) fragments in CT imaging of posterior pilon variant fractures, and to provide help for clinical diagnosis and treatment.

Methods

CT imaging data of 109 cases of posterior pilon variant fractures in our hospital from January 2013 to December 2020 were retrospectively analyzed. According to Mason and Molloy classification, PM fragments were further divided into pilon subtypes and avulsed subtypes. The largest actual area of fragments in axial and sagittal were selected as the study plane, and the maximum axial lengths of X, Y and Z, α angle, β angle, fragment area (S1–7) and fragment area ratio (FAR1-4), interfragmentary (IF) angle, and back of tibia (BT) angle were measured.

Results

A total of 109 cases were included in this study, 61 of whom were pilon subtypes [90.16% were supination-external rotation (SER) injuries]. 48 cases were avulsed subtypes [81.25% were pronation-external rotation (PER) injuries]. Pilon subtypes were larger than avulsed subtypes in X, Y, Z, α2 Angle, β2 Angle, fragment area and ratio, and IF and BT angle (P < 0.05). There was no difference between α1 and β1 angle (P > 0.05).

Conclusion

The morphology of pilon subtype was larger than that of avulsion subtype. According to fragment size, morphology, and injury mechanism, two fragments of pilon subtype should be anatomic reduction and fixation. However, the PL fragment of avulsion subtype should to be fixed, while PM fragment may only need conservative treatment.

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Acknowledgements

We would like to give our sincere appreciation to the reviewers for their helpful comments on this article.

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Authors and Affiliations

  1. Department of Orthopaedics, Taizhou Hospital of Zhejiang Province, Taizhou, 318000, Zhejiang, People’s Republic of China

    Chenglong Wang

  2. Department of Orthopaedics, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People’s Republic of China

    Chengwei Chen, Yeli Zhou & Zhe-er Pan

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  1. Chenglong Wang
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  2. Chengwei Chen
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  4. Zhe-er Pan
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Contributions

WCL: design of investigation, data collection, data analysis, and writing paper. CCW: data analysis and writing paper. ZYL: data collection. PZE: design of investigation, data collection, data analysis, and writing paper.

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Correspondence to Zhe-er Pan.

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This work was approved by the Ethics Committee of the First Affiliated Hospital of Wenzhou Medical University. All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Wang, C., Chen, C., Zhou, Y. et al. Morphological study of CT image of posterior pilon variant fracture and its possible clinical significance. Arch Orthop Trauma Surg 143, 1203–1215 (2023). https://doi.org/10.1007/s00402-021-04224-0

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  • DOI: https://doi.org/10.1007/s00402-021-04224-0

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