Recherche clinique sur le pied et la cheville

Abstrait

Minimally Invasive Treatment Protocol for Closed Pilon Fractures

Sherif Mohamed Abdelgaid, Mohamed Abdulghany Ahmed and Emad Gaber Abdel-Mageed

Introduction: high-energy injuries of distal tibia are usually associated with serious bony and soft tissues complications. Surgical options include biologic or open, internal or external fixation and primary arthrodesis with a lot of available fixation tools with no one treatment method has demonstrated superiority over others.
Material & Methods: from January 2007 to December 2010, 72 patients with closed pilon fractures managed by minimally invasive techniques according to a suggested protocol in the Al-Razi orthopedic hospital in Kuwait. Protocol is designed to choose minimally invasive treatment option depends on: 1) regional classification of soft tissue injuries, 2) grade of soft tissue injury & 3) degree of bony comminution.
Results: the mean follow up period was 34 months (range: 24–48 months). According to Tornetta clinical scoring system 35 (48.5%) patients were assessed as excellent, 29 patients with good results (40.5%), 5 patients (7%) assumed fair results and 3 patients (4%) had poor results. Using Teeny & Wiss radiologic scoring system, 43 patients (59.5%) achieved excellent results, 24 patients (33.5%) achieved good results, 4 patients (5.5%) with fair results and only one patient (1.5%) with poor result.
Conclusion: The designed protocol of minimally invasive treatment for closed pilon fractures provides the treating surgeon a variety of treatment options aiming to decrease the high rate of soft tissues and bony complications reported with these complex injuries.The unfavorable results will be decreased more if this protocol is combined with soft tissues stretching rehabilitation program and weight bearing is postponed until bony union become evident both clinically and radiologically.