Talk about the treatment of Pilon fracture

Pilon fracture is a type of fracture that is difficult to treat in orthopedics. It refers to a comminuted or compressed fracture of the ankle joint in the distal tibia of the patient. Usually, the patient is accompanied by a fracture of the distal or proximal fibula. The main way to treat Pilon fractures is surgical treatment.

Types of Pilon fractures
Type Ⅰ Pilon fractures generally occur in the distal tibia, showing a crack fracture, and there is no displacement of the articular surface of the patient; Type Ⅱ Pilon fracture patients have a displacement of the articular surface, but the dry epiphysis of the articular surface There is no comminuted fracture above the end; if the patient is a type III Pilon fracture, it is likely to involve the tibial articular surface, and there is a comminuted fracture in the metaphysis and articular cartilage.

The above is the classification based on CT examination, which focuses on the degree of articular surface injury of the distal tibia of the patient. However, there is no mention of the injury mechanism of Pilon fractures. The classification of Pilon fracture types is relatively simple and general.

Type A Pilon fractures are extra-articular fractures; Type B Pilon fractures are fractures of some joints; Type C Pilon fractures refer to fractures of the entire joint; Type C1 Pilon fractures refer to simple metaphyseal fractures and joint fractures; Type C2 Pilon fractures Fracture refers to a simple joint fracture, accompanied by comminuted metaphyseal fractures; C3 Pilon fracture refers to a relatively serious comminuted fracture from the joint to the metaphysis.

The above method of dividing the Pilon fracture type only describes the location and severity of the fracture.

Conservative treatment of Pilon fractures
1. Physical indications for conservative treatment of Pilon fractures. ①The patient is a type Ⅰ Pilon fracture, there is no obvious displacement, and the degree of soft tissue injury is not very serious; ②The patient’s joint morphology is normal, but there is a serious comminuted fracture; ③The patient’s physical condition is relatively poor, The body does not tolerate surgery.

2. The method of treating Pilon fractures. After the Pilon fracture was closed and reduced, plaster was used to fix the fracture site. If the soft tissue injury of Pilon fracture patients is more serious, and the ankle joint of patients with early fractures can move, then it can be treated by bone traction. The operation of bone traction treatment is relatively simple and easy to operate.

3. Disadvantages of conservative treatment. Closed reduction and external fixation of plaster can not maintain the normal length of the patient’s affected limb. Because the gypsum has fixed the patient’s joint, the patient’s movement is bound to be restricted, which is very unfavorable for the healing of the injured joint. After bone traction, the patient can no longer walk, and the joint cannot be reduced by surgery.

Surgical treatment of Pilon fracture
1. Indications for surgery to treat Pilon fractures. ①The patient with Pilon fracture is an open fracture; ②It is accompanied by vascular injury; ③There is displacement in the articular surface, and the displacement distance is greater than 2 mm, or the displacement step is greater than 1 mm.

2. The timing of surgical treatment of Pilon fractures. If the patient is a comminuted fracture of the distal tibia, it is easy to cause compression and contusion of the surrounding nerves and blood vessels. Patients receive surgical treatment within 8 to 10 hours after the fracture, which can not only avoid skin necrosis and infection at the fracture site, but also relieve soft tissue swelling.

If the patient’s physical condition is not very good or due to some other factors, the conditions of the surgery are not met, then the medical staff should temporarily fix the patient’s fracture site and raise the patient’s limb. After the patient’s soft tissue conditions have improved significantly, and the swelling has subsided, or the tension blisters have all subsided, surgery can be performed.

3. Standard procedure for surgical treatment of Pilon fractures. The doctor first restores the fibula to its normal length and fixes the fibula, then re-establishes the critical face of the tibia, fills in the patient’s bone defect, and finally supports the medial side of the patient’s tibia. The stability of the ankle point can promote the fibula to return to its normal position, length and integrity of the lower tibiofibular ligament. After the fibula is accurately reset, it can provide an important reference for the accurate reduction of other parts. However, the position of the lateral tibia joint is relatively deep, and there are certain difficulties in reduction. If necessary, the tibial joint and ankle points can be fully exposed to expose the medial malleolus, anterior and lateral tibia bones, etc. The block is completely reset. If the patient’s bone is defective, bone grafting should be performed after reduction. Usually, even if there is a comminuted fracture of the cortical bone on the medial tibia, there is generally no defect. Just use a tri-lobe plate or a locking plate to fix the medial tibia to keep the medial cortex in a stable state. If the patient’s tibial fracture appears as a coronal plane, then the doctor will generally use a tri-lobe plate to support the front of the patient’s tibia. During the operation, the doctor will protect the patient’s skin and the anterior tendon to the maximum extent. The incision between the tibia and fibula should not be less than 8 cm. In order to avoid disrupting the normal circulation of blood in front of the tibia, in order to prevent the fracture site Necrosis of the skin.

4. Surgical treatment of possible complications of Pilon fractures. Surgical treatment of Pilon fractures has a high probability of complications, and some early complications are usually related to the patient’s soft tissue. However, patients do not have to worry too much. They must trust the professionalism of the doctor. During the operation, the doctor will protect the soft tissue of the patient as much as possible. If the patient’s local swelling is serious and the tension of the wound is relatively large, the doctor will sew the patient’s wound by reducing the tension and place a drainage strip on the wound site to avoid the wound from cracking and infection. After the operation, the patient should elevate the affected limb and administer a small amount of mannitol to reduce swelling.