Abstract
Ninety-eight pilon fractures associated with ipsilateral distal fibular fracture were included in this study. The pilon fractures were treated by open reduction and plating. The 98 fractures were divided into three groups based on the treatment method of fractured fibula. Group A was composed of 50 fibular fractures treated by open reduction and plate fixation. Group B was composed of 23 fibular fractures treated by open reduction and pin fixation. Group C was composed of 25 fibular fractures treated conservatively by closed reduction. The radiographs were reviewed for adequacy of fracture reduction and posttraumatic arthrosis. At the end of follow-up, the clinical outcomes were evaluated using a rating scale. The three groups were similar in respect to Ruedi type, open fracture grade, and demographics (all p values >0.25). Group A showed a decreasing trend of malunion and ankle arthrosis compared to group C (p = 0.091 and p = 0.099, respectively). Group A had a better clinical outcome than group C (p = 0.008). In addition, group A showed an increasing trend of satisfactory outcome compared to group B (p = 0.096). In conclusion, for pilon fractures associated with ipsilateral fibular fractures, stabilisation of the fractured fibula plays an important role in the decrease of distal tibial malunion and post-traumatic ankle arthrosis as well as improvement of clinical outcomes.
Résumé
98 fractures du pilon tibial avec fracture du péroné ont été inclus dans cette étude. Les fractures du pilon tibial ont été traitées par réduction sanglante et ostéosynthèse par plaque. Les 98 fractures ont été divisées en 3 groupes selon les méthodes de traitement du péroné fracturé. Le groupe A était composé de 50 fractures du péroné traitées par réduction sanglante et plaque, le groupe B de 23 fractures du péroné traitées par réduction sanglante et fixations par broches et le groupe C de 25 fractures du péroné qui ont été réduites sans fixation. Les radiographies ont été analysées afin d’évaluer la réduction de la fracture et l’évolution vers une arthrose post-traumatique. A la fin du suivi, les trois groupes étaient identiques sur le plan clinique le type de Ruedi, le stade d’ouverture et les données démographiques. Le groupe A montrait un nombre moins important de pseudarthrose et d’arthrose de la cheville comparé au groupe C (p = 0,091, p = 0,099 respectivement). Le groupe A avait un meilleur résultat clinique que le groupe C (p = 0,008). De plus, le groupe A montrait une amélioration plus satisfaisante sur le devenir clinique à long terme que le groupe B (p = 0,096). En conclusion, les fractures du pilon tibial présentant une fracture associée du péroné doivent être stabilisées au niveau du tibia et au niveau du péroné par une ostéosynthèse par plaques de façon à diminuer le nombre de cals vicieux postraumatiques et d’améliorer les résultats cliniques.
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Lee, YS., Chen, SW., Chen, SH. et al. Stabilisation of the fractured fibula plays an important role in the treatment of pilon fractures: a retrospective comparison of fibular fixation methods. International Orthopaedics (SICOT) 33, 695–699 (2009). https://doi.org/10.1007/s00264-008-0654-4
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DOI: https://doi.org/10.1007/s00264-008-0654-4