دورية أكاديمية
Fracture reduction and primary ankle arthrodesis: a reliable approach for severely comminuted tibial pilon fracture.
| العنوان: | Fracture reduction and primary ankle arthrodesis: a reliable approach for severely comminuted tibial pilon fracture. |
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| المؤلفون: | Beaman DN; Summit Orthopaedics, 501 North Graham, Suite 250, Portland, OR, 97227, USA, dnbeaman@gmail.com., Gellman R |
| المصدر: | Clinical orthopaedics and related research [Clin Orthop Relat Res] 2014 Dec; Vol. 472 (12), pp. 3823-34. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Wolters Kluwer Country of Publication: United States NLM ID: 0075674 Publication Model: Print Cited Medium: Internet ISSN: 1528-1132 (Electronic) Linking ISSN: 0009921X NLM ISO Abbreviation: Clin Orthop Relat Res Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2018- : [New York, NY] : Wolters Kluwer Original Publication: Philadelphia : Lippincott, |
| مواضيع طبية MeSH: | Arthrodesis*/adverse effects, Ankle Joint/*surgery , Fractures, Comminuted/*surgery , Tibia/*surgery , Tibial Fractures/*surgery, Adult ; Aged ; Ankle Joint/diagnostic imaging ; Ankle Joint/physiopathology ; Disability Evaluation ; External Fixators ; Female ; Fracture Fixation/adverse effects ; Fracture Fixation/instrumentation ; Fracture Fixation/methods ; Fracture Fixation, Internal ; Fracture Healing ; Fractures, Comminuted/diagnosis ; Humans ; Male ; Middle Aged ; Reoperation ; Retrospective Studies ; Severity of Illness Index ; Tibia/diagnostic imaging ; Tibia/injuries ; Tibia/physiopathology ; Tibial Fractures/diagnosis ; Time Factors ; Tomography, X-Ray Computed ; Treatment Outcome |
| مستخلص: | Background: Posttraumatic arthritis and prolonged recovery are typical after a severely comminuted tibial pilon fracture, and ankle arthrodesis is a common salvage procedure. However, few reports discuss the option of immediate arthrodesis, which may be a potentially viable approach to accelerate overall recovery in patients with severe fracture patterns. Questions/purposes: (1) How long does it take the fracture to heal and the arthrodesis to fuse when primary ankle arthrodesis is a component of initial fracture management? (2) How do these patients fare clinically in terms of modified American Orthopaedic Foot and Ankle Society (AOFAS) scores and activity levels after this treatment? (3) Does primary ankle arthrodesis heal in an acceptable position when anterior ankle arthrodesis plates are used? Methods: During a 2-year period, we performed open fracture reduction and internal fixation in 63 patients. Eleven patients (12 ankles) with severely comminuted high-energy tibial pilon fractures were retrospectively reviewed after surgical treatment with primary ankle arthrodesis and fracture reduction. Average patient age was 58 years, and minimum followup was 6 months (average, 14 months; range, 6-22 months). Anatomically designed anterior ankle arthrodesis plates were used in 10 ankles. Ring external fixation was used in nine ankles with concomitant tibia fracture or in instances requiring additional fixation. Clinical evaluation included chart review, interview, the AOFAS ankle-hindfoot score, and radiographic evaluation. Results: All of the ankle arthrodeses healed at an average of 4.4 months (range, 3-5 months). One patient had a nonunion at the metaphyseal fracture, which healed with revision surgery. The average AOFAS ankle-hindfoot score was 83 with 88% having an excellent or good result. Radiographic and clinical analysis confirmed a plantigrade foot without malalignment. No patients required revision surgery for malunion. Conclusions: Primary ankle arthrodesis combined with fracture reduction for the severely comminuted tibial pilon fracture reliably healed and restored acceptable function in this highly selective patient group. Ring external fixation may be a useful adjunct to internal fixation, and this concept should be further studied. Level of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. |
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| تواريخ الأحداث: | Date Created: 20140522 Date Completed: 20150309 Latest Revision: 20211021 |
| رمز التحديث: | 20240628 |
| مُعرف محوري في PubMed: | PMC4397758 |
| DOI: | 10.1007/s11999-014-3683-x |
| PMID: | 24844887 |
| قاعدة البيانات: | MEDLINE |
Find this article in full text from Springer Verlag. 
Full Text Finder | تدمد: | 1528-1132 |
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| DOI: | 10.1007/s11999-014-3683-x |