Tibia pilon kırıkları: Tek merkez deneyimi

Öz

Amaç: Bu çalışmanın amacı cerrahi tedavi uygulanan tibia pilon kırıklarının orta dönem klinik sonuçlarını incelemektir. Gereç ve Yöntemler: 2002-2012 yılları arasında, tibia pilon kırığı nedeni ile cerrahi olarak tedavi edilmiş 20 hasta çalışmaya dahil edilmiştir. Çalışmaya dahil edilen hastalar fonksiyonel açıdan Weber ve Amerikan Ortopedik Ayak ve Ayak Bileği Derneği (AOFAS) protokolüne göre değerlendirildi. Bulgular: Hastaların ortalama izlem süresi 31.55 (20-48 ay) aydı. Hastaların 9’u (%45) açık kırıktı. Ruedi Allgöwer Sınıflamasına gore 9 hastada tip 1, 9 hastada tip 2 (%45) ve 2 hastada tip 3 kırık mevcuttu. Kapalı kırıklar ile açık kırıkların kaynama süreleri karşılaştırıldığında, açık kırıklarda kaynama süreleri anlamlı bir şekilde uzun bulundu (p=0,004). Aşamalı tespit yaptığımız hasta grubunda yumuşak doku komplikasyonlarının direk tespit uygulanan hastalara göre oransal olarak daha az geliştiği görüldü ancak istatistiksel olarak anlamlı bir farka rastlanmadı (p=0,999). Sonuç: Pilon kırıklarının cerrahi tedavi aşamasında, yumuşak dokuya maksimum saygı ve özen gösterilmelidir. Bazı kırıkların kaderinin olay anında çizildiği ve tüm çabalara rağmen bazı hastalarda kötü sonuçların kaçınılmaz olduğu unutulmamalıdır.

Anahtar Kelimeler

• Pilon Kırıkları
• Tibia Kırıkları
• Kırıklar
• Weber ve AOFAS
• Travma

Tibial pilon fractures: Single center experience

Öz

Aim: This study aims to investigate the mid-term clinical outcomes of surgically treated Pilon Fractures (PF). Material and Methods: Twenty patients, surgically treated for PF between 2002 and 2012 were included in the study. Patients were evaluated functionally based on the Weber and American Orthopaedic Foot & Ankle Society (AOFAS) protocols. Results: Mean follow-up period was 31.55 (20–48) months. Nine (45%) of the 20 patients had open fractures. According to the Rüedi–Allgöwer Classification: type 1 in nine, type 2 in nine (45%) and type 3 fractures were observed in two patients. A comparison of the duration of union between closed and open fractures revealed that the union of open fractures took a significantly longer time (p= 0.004). Moreover, soft tissue complications developed to a proportionally lesser extent in patients who were applied staged fixation compared with those were applied direct fixation, although the difference was not statistically significant (p= 0.999). Conclusion: The surgical treatment phase of PF should comply with maximum care provided and attention paid to soft tissue. It should be remembered that the fate/outcome of certain fractures is determined at the time of the incident and that certain negative outcomes are inevitable in some patients despite the best efforts.

Anahtar Kelimeler

• Pilon fractures
• Tibial fractures
• Fractures
• Weber and AOFAS
• Trauma

Kaynakça

1. 1. Mauffrey C, Vasario G, Battiston B, Lewis C, Beazley J, Seligson D. Tibial pilon fractures: A review of incidence, diagnosis, treatment, and complications. Acta Orthop Belg 2011; 77: 432
2. 2. Brumback RJ, McGarvey WC. Fractures of the tibial plafond. Evolving treatment concepts for the pilon fracture. Orthop Clin North Am 1995; 26: 273-285
3. 3. Craig S, Bartlett C, Lon S. Fracture of the tibial pilon. In: Browner B, Jupiter J, Levine A, et al., eds. Skeletal Trauma, 3rd edn. Singapore: Elsevier, 2003; 2257.
4. 4. Zelle BA, Dang KH, Ornell SS. High-energy tibial pilon fractures: an instructional review. Int Orthop 2019; 1-12.
5. 5. Rüedi TP, Allgöwer M. Fractures of the lower end of the tibia into the ankle joint. Injury 1969; 1: 92-9.
6. 6. Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am 1976; 58: 453–8
7. 7. Gustilo RB, Mendoza RM, Williams DN. Problems in management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma 1984; 24: 742–6
8. 8. Ruedi TP, Allgöwer M. The operative treatment of intra-articular fractures of the lower end of the tibia. Clin Orthop Relat Res 1979; 138: 105-10.

9. 9. Meinberg EG, Agel J, Roberts CS, Karam MD, Kellam JF. Fracture and Dislocation Classification Compendium- 2018. J Orthop Trauma 2018; 32: 1-10.
10. 10. Tscheme H, Gotzen L. Fractures with soft tissue injuries. Berlin, Eieidelberg, Springer-Verlag, 1984.
11. 11. Kellam JF, Waddel JP. Fractures of the distal tibial metaphysis with intraarticular extension-the distal tibial explosion fracture. J Trauma 1979; 19: 593-601.
12. 12. Ganz R, Etter C. Long-term results of tibial plafond fractures treated with open reduction and internal fixation. Arch Orthop Trauma Surg 1991; 110: 277-283.
13. 13. Watson JT, Moed BR, Karges DE, Cramer KE. Pilon fractures. Treatment protocol based on severity of soft tissue injury. Clin Orthop Relat Res 2000; 375: 78-90.
14. 14. Ovadia DN, Beals RK. Fractures of the tibial plafond. J Bone Joint Surg Am 1986; 68: 543-51.
15. 15. Bone L, Stegemann P, McNamara K, Siebel R. External fixation of severely communited and open tibial pilon fractures. Clin Orthop Relat Res 1993; 292: 101-7.
16. 16. Patterson MJ, Cole JD. Two-staged delayed open reduction and internal fixation of severe pilon fractures. J Orthop Trauma 1999; 13: 85-91
17. 17. Helfet DL, Suk M. Minimally invasive percutaneous plate osteosynthesis of fractures of the distal tibia.  Instr Course Lect 2004; 53: 471-5.
18. 18. Blauth M, Bastian L, Krettek C, Knop C, Evans S. Surgical options for the treatment of severe tibial pilon fractures: a study of three techniques. J Orthop Trauma 2001; 15: 153-60
19. 19. Teeny SM, Wiss DA. Open reduction and internal fixation of tibial plafond fractures. Variables contributing to poor results and complications. Clin Orthop Relat Res 1993; 292: 108- 17.
20. 20. Bourne RB, Rorabeck CH, Macnab J. Intra-articular fractures of the distal tibia: The pilon fracture.  J Trauma 1983; 23: 591-6.
21. 21. Williams TM, Marsh JL, Nepola JV, DeCoster TA, Hurwitz SR, Bonar SB.  External fixation of tibial plafond fractures: is routine plating of the fibula necessary? J Orthop Trauma 1998; 12: 16-20.
22. 22. Civan O, Alimoğlu B, İçen M, Taşkın S, Cavit A, Söyüncü Y, Ürgüden M. Pediatric tibial shaft and distal metaphyseal fractures. Jt Dis Relat Surg 2020; 31: 532-40.
23. 23. Fırat A, Tecimel O, Işık Ç, Özdemir M, Öçgüder A, Bozkurt M. Ilizarov External Fixator in the Management of Tibial Pilon Fractures: Ankle Hinged vs Ankle Fixed Frame. Eklem Hastalik Cerrahisi 2013; 24: 133–8.