J Korean Foot Ankle Soc.  2019 Sep;23(3):110-115. 10.14193/jkfas.2019.23.3.110.

Result of Staged Operation in Ruedi-Allgower Type II and III Open Tibia Pilon Fractures with Severe Comminution

Affiliations
  • 1Department of Orthopaedic Surgery, College of Medicine, Chosun University, Gwangju, Korea. leejy88@chosun.ac.kr

Abstract

PURPOSE
This study analyzed the clinical and radiological results of Reudi-Allgower type II and III open tibia pilon fracture patients who underwent plate fixation after the recovery of a soft tissue injury after external fixation.
MATERIALS AND METHODS
From 2010 to 2015, this study analyzed 14 patients who were treated for open tibial pilon fractures and could be followed up at least one year. The mean age was 49 years and the average follow-up period was 19 months. An emergency operation was performed for external fixation and open wounds, and secondary surgery was performed for definitive fixation using a plate. The radiological and clinical evaluations were analyzed retrospectively. Complications, such as post-traumatic osteoarthritis and wound infections were also analyzed.
RESULTS
The mean duration between two-staged surgery was 21 days and the mean bone union time was 9.2 months. Three cases of delayed union and one case of nonunion were reported. The malunion did not occur in all cases. The average American Orthopaedic Foot and Ankle Society (AOFAS) score was 68 points. A limitation of the ankle motion occurred in all cases. In four cases, wound infections due to initial open wounds occurred; one patient underwent a below the knee amputation due to chronic osteomyelitis. Post-traumatic arthritis occurred in 10 cases.
CONCLUSION
Severe comminuted tibial plateau open fractures of Reudi-Allgower type II and III, which are high-energy injuries that result in extensive soft tissue damage, have a higher incidence of complications, such as ulcer problems and osteomyelitis, than closed tibia plateau fractures. Post-traumatic arthritis is the most common complication of tibia plateau open fractures, and staged surgery is recommended because of the relatively satisfactory clinical results.

Keyword

Tibia; Open tibia pilon fracture; Staged operation

MeSH Terms

Amputation
Ankle
Arthritis
Emergencies
Follow-Up Studies
Foot
Fractures, Open
Humans
Incidence
Knee
Osteoarthritis
Osteomyelitis
Retrospective Studies
Soft Tissue Injuries
Tibia*
Ulcer
Wound Infection
Wounds and Injuries

Figure

  • Figure 1 Initial operation with external fixator and fibular fixation. (A) Anteroposterior X-ray. (B) Lateral X-ray.

  • Figure 2 Second staged definitive fixation with 3.5 mm locking compression plate for distal tibial fracture. (A) Anteroposterior X-ray. (B) Lateral X-ray.

  • Figure 3 Approach to tibial fracture at 2nd operation, anterolatreal approach (A), posterolateral approach (B), medial approach (C).

  • Figure 4 X-ray 10 months after operation shows nonunion. (A) Anteroposterior X-ray. (B) Lateral X-ray.

  • Figure 5 X-ray 6 months after operation shows delayed union. (A) Anteroposterior X-ray. (B) Lateral X-ray.

  • Figure 6 Post-traumatic osteoarthritis. (A) Anteroposterior X-ray. (B) Lateral X-ray.

  • Figure 7 Ankle joint incongruency after trauma. (A) Anteroposterior Xray. (B) Lateral X-ray.

  • Figure 8 X-ray 4 months after operation shows screw breakage.


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