A two-choice strategy through a medial tibial approach for the treatment of pilon fractures with posterior or anterior fragmentation

胫骨的 ObjectiveThe 在前面偏一边的途径为胫骨的 pilon 破裂的管理被推广了。为复杂破裂模式，一条联合 anterolateral/anteromedial 途径合适，但是复杂并发症的高率被报导了。在我们的回顾的学习，采用一条中间的胫骨的途径的二选择的策略在胫骨的 pilon 破裂的解剖研究上与前面或以后的 fragmentation.MethodsBased 为 pilon 破裂的处理被建议，我们回顾地分析了破裂与主要以后、以后侧面或前面，前面侧面( Tillaux-Chaput )远侧的胫骨的参与。这回顾的研究与关上的胫骨的天花板破裂由 18 个病人组成了。包括标准是：( 1 )前面/在前面偏一边的类型碎片的存在或一以后( Volkmann )打碎片包含>25%关节的表面，( 2 ) 12 个月的最小的后续，( 3 )腓骨破裂与远侧的胫骨的中间的列破裂联系了，并且( 4 )软组织在没损害外科的存取的选择的操作的时候调节(为关上的破裂的 Tscherne 分类：分级 0 和等级 1 ) 。胫骨的天花板破裂被分类进二个组：有以后的边界(Volkmann ) 的前面的介绍的和其它 fragments.ResultsMost 病人以运动和 Olerud-Molander 规模分数的范围完成了好临床的恢复。仅仅三个病人介绍了一个等级在是的二选择的策略热点概念以前在文学辩论了并且描述的 12 月 follow-up.ConclusionOur 的 2 骨关节炎。但是为远侧的胫骨的外科的途径的一个新扩大协议，包括更多的破裂模式和他们的协会应该进一步被调查。

Objective： The anterolateral approach to the tibia has been popularized for the management of tibial pilon fractures. For complex fracture patterns a com- bined anterolateral/anteromedial approach is suitable but a high rate of complication has been reported. In our retro- spective study a two-choice strategy adopting a medial tibial approach was proposed for the treatment of pilon fractures with anterior or posterior fragmentation. Methods： Based on an anatomic study oftibial pilon fractures, we retrospectively analyzed the fractures with primary posterior, posterior-lateral or anterior, anterior-lat- eral （Tillaux-Chaput） involvement of the distal tibia. This retrospective study consisted of 18 patients with a closed tibial plafond fracture. The inclusion criteria were： （1） pre- sence of an anterior/anterolateral type fragment or a poste- rior （Volkmann） type fragment involving 〉25% of the articu- lar surface, （2） a minimum follow-up of 12 months, （3） a fibula fracture associated with a medial colunm fracture of the distal tibia, and （4） soft tissue conditions at the time of opera- tion that did not compromise the choice of surgical access （Tscheme classification for closed fractures： grade 0 and grade 1）. Tibial plafond fractures were classified into two groups： one presenting anterior and the other with poste- rior rim （Volkmann） fragments. Results： Most patients achieved a good clinical re- covery in terms of range of motion and Olerud-Molander scale scores. Only three patients presented a grade 2 os- teoarthritis at the 12 month follow-up. Conclusion： Our two-choice strategy highlights con- cepts which have been previously debated and described in the literature. But a new extended protocol for surgical approach to the distal tibia, including more fracture pat- terns and their association should be further investigated.