Development of Minimally Invasive Strategies for Tibial Pilon Fractures

Öz

İntroduction-Aim: The research evaluates minimally invasive surgical techniques for tibial pilon fractures through AO/OTA classification while assessing clinical and radiological results and determining predictive elements. Methods: Between January 2019 and December 2022, 30 patients (18 males, 12 females) diagnosed with AO/OTA type 43-B and 43-C tibial pilon fractures and treated with minimally invasive surgery were retrospectively analysed. Patients were treated with percutaneous fixation (n=14) or minimally invasive plate osteosynthesis (n=16). The AOFAS score and pain VAS score and SF-36 were used to evaluate functional outcomes while articular reduction and joint step and alignment measurements were used to evaluate radiological outcomes. Results: The mean patient age was 45±12 years, and the mean follow-up period was 24 months. The rate of anatomical reduction was significantly higher in Type B fractures (87.5%) compared to Type C fractures (57.1%) (p=0.008). AOFAS scores reached an average of 85±8 at 12 months, but decreased significantly with increasing AO/OTA classification (β=-0.45, p=0.001). The risk of post-traumatic arthritis was significantly increased in AO type C2/C3 fractures (OR=6.8, p<0.001) and in cases with joint step-off >2 mm (OR=7.5, p<0.001). Conclusion: The treatment of tibial pilon fractures benefits from minimally invasive surgical approaches. The AO/OTA classification demonstrates prognostic value because functional and radiological outcomes worsen as fracture complexity increases. The surgical approach needs to be tailored based on the fracture pattern and individual patient factors.

Anahtar Kelimeler

• Fracture Fixation
• Minimally Invasive
• Tibial Fractures;

Tibial Pilon Kırıkları için Minimal İnvaziv Stratejilerin Geliştirilmesi

Öz

Giriş -Amaç: Bu araştırma, AO/OTA sınıflandırmasına göre tibial pilon kırıkları için minimal invaziv cerrahi teknikleri değerlendirirken, klinik ve radyolojik sonuçları değerlendirip prediktif faktörleri belirlemeyi amaçlamaktadır. Yöntemler: Ocak 2019 ile Aralık 2022 tarihleri arasında AO/OTA tip 43-B ve 43-C tibial pilon kırıkları tanısı alan ve minimal invaziv cerrahi ile tedavi edilen 30 hasta (18 erkek, 12 kadın) retrospektif olarak analiz edilmiştir. Hastalar perkütan fiksasyon (n=14) veya minimal invaziv plaka osteosentezi (n=16) ile tedavi edildi. Fonksiyonel sonuçları değerlendirmek için AOFAS skoru ve ağrı VAS skoru ile SF-36 kullanılırken, radyolojik sonuçları değerlendirmek için eklem redüksiyonu ve eklem basamağı ve hizalama ölçümleri kullanıldı. Bulgular: Hastaların ortalama yaşı 45±12 yıl, ortalama takip süresi 24 aydı. Anatomik redüksiyon oranı, Tip B kırıklarda (87,5%) Tip C kırıklara (57,1%) göre anlamlı olarak daha yüksekti (p=0,008). AOFAS skorları 12 ayda ortalama 85±8'e ulaştı, ancak AO/OTA sınıflandırması arttıkça anlamlı olarak azaldı (β=-0,45, p=0,001). Travma sonrası artrit riski, AO tip C2/C3 kırıklarda (OR=6,8, p<0,001) ve eklem basamağı >2 mm olan vakalarda (OR=7,5, p<0,001) anlamlı olarak artmıştır. Sonuç: Tibial pilon kırıklarının tedavisinde minimal invaziv cerrahi yaklaşımlar faydalıdır. AO/OTA sınıflandırması, kırık karmaşıklığı arttıkça fonksiyonel ve radyolojik sonuçların kötüleştiği için prognostik değer taşımaktadır. Cerrahi yaklaşım, kırık tipine ve hastanın bireysel faktörlerine göre uyarlanmalıdır.

Anahtar Kelimeler

• Kırık Fiksasyonu
• Minimal İnvaziv;
• Tibial Kırıklar;

Kaynakça

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