경골 간부로 연장된 천정 골절에서 외고정술과 동반한 조기 후내측 금속판 고정술 : 단기 추시 결과

Abstract

Purpose: Early limited plate fixation was performed for diaphyseal extensions in tibia pilon fractures with initial spanning external fixation. After this procedure, we performed definitive fixation when soft tisse conditions permit. The purpose of our study is to report the result of this technic for diaphyseal extented tibia pilon fractures. Materials and Methods: From July 2012 to October 2015, 8 patients with a fracture line extended to the tibial shaft were treated with 1st-stage external fixation and early limited plate fixation. The elongated fracture line was a spiral or long oblique fracture. The soft tissue condition of tibial shaft was limited to the case where skin incision was possible. After the minimal incision on posteromedial side, the fixation were performed by one-third semitubular plate. And then ankle spanning external fixation was performed combined with lateral melleolar fracture reduction and fixation by typical method. After 1-3 weeks, the soft tissue was stabilized and the definitive fixation was performed for reconstruction of the joint surface. The results were divided into clinical and radiological results. Radiological evaluation was graded by the criteria of Burwell and Charnley, functional assessment was evaluated by the AOFAS score (American Orthopedic Foot and Ankle Society score). Results: At the final follow-up, all fractures were healed, and the mean union period was 18 weeks (14-30 weeks). Soft tissue complications such as infection or skin necrosis did not occur in all cases. At the final operation, an anatomical reduction was achieved easily. According to the criteria of Burwell and Charnley, radiologic results showed in 7 cases (87.5%) with anatomical reduction or above normal. AOFAS average score was 79, which was satisfactory. Posttraumatic arthritis occurred in 3 cases. Conclusion: The surgical procedure is easy to accomplish by reducing the tibial shaft fracture at an early stage, and even when the fracture of the joint is reduced at the final operation, the anatomical reduction can be facilitated by the reduction of the structural skeleton beforehand. And the damage of soft tissues could be minimized. However, depending on the medical condition and soft tissue state, it may be used in limited indications, and further long-term follow-up studies are needed.