Corrective intra-articular osteotomy for malreduced tibial pilon fractures in young patients
10.3760/cma.j.cn115530-20241101-00430
- VernacularTitle:经关节内矫正截骨术治疗中青年陈旧性胫骨pilon骨折的疗效分析
- Author:
Tingjiang GAN
1
;
Yaxing LI
1
;
Yu CHEN
1
;
Hui ZHANG
1
Author Information
1. 四川大学华西医院骨科/骨科研究所，成都 610041
- Publication Type:Journal Article
- Keywords:
Tibia;
Fractures, bone;
Osteotomy;
Pilon fractures;
Old fractures
- From:
Chinese Journal of Orthopaedic Trauma
2025;27(1):25-31
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate corrective intra-articular osteotomy in the treatment of malreduced tibial pilon fractures in young patients.Methods:A retrospective study was conducted to analyze the 23 patients who had been treated for malreduced tibial pilon fractures by corrective intra-articular osteotomy from January 2013 to December 2022 at Department of Orthopedics, Orthopedic Research Institute, West China Hospital. They were 21 males and 2 females with a median age of 42.9(28.6, 48.1) years. The median interval between intra-articular osteotomy and initial injury or previous surgery was 97 (51, 166) d. The clinical efficacy was assessed by the ankle-hindfoot score of American Orthopaedic Foot and Ankle Society (AOFAS), MOS item short form health survey (SF-36), visual analog scale (VAS) pain score, ankle range of motion (ROM), modified Kellgren-Lawrence arthritis grading, and complications.Results:The median follow-up period was 35.4 (26.2, 72.2) months. At the last follow-up, the AOFAS ankle-hindfoot score, SF-36, VAS pain score, and ankle ROM for all patients were, respectively, (80.7±12.1) points, (72.2±13.9) points, 2.0(0, 3.0) points and 23.0°(18.0°, 30.0°), and the modified Kellgren-Lawrence arthritis grading revealed stage Ⅱ in 17 cases, stage Ⅲ in 5 cases, and stage Ⅳ in 1 case. For the 12 patients with sufficient preoperative data, the AOFAS ankle-hindfoot score [(80.9±10.1) points], SF-36 [(72.9±12.0) points], VAS pain score [2.5 (0.5, 3.0) points], and ankle ROM (26.5°±7.9°) at the last follow-up were significantly better than the preoperative values [(42.2±16.0) points, (36.0±8.8) points, 6.0 (5.5, 6.5) points, and 21.3°±7.0°] (all P<0.05). One patient who experienced significant pain postoperatively planned to receive ankle fusion surgery. No patients experienced deep infection, fracture non-union, or failure of internal fixation. Conclusion:Corrective intra-articular osteotomy may be a viable alternative treatment of malreduced tibial pilon fractures in young patients, because it can effectively improve short-term clinical and radiographic outcomes.
