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 h...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.展开更多
文摘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.
