Réduction à ciel ouvert des fractures malléolaires postérieures du pilon tibial : évaluation clinique et radiologique - 21/07/17

Open reduction in pilon variant posterior malleolar fractures: Radiological and clinical evaluation

Doi : 10.1016/j.rcot.2017.06.003

E. Sukur ^a,^⁎ , Y.E. Akman ^b, H.B. Gokcen ^c, E.C. Ozyurek ^d, A. Senel ^d, Y. Ozturkmen ^d
^a Department of orthopedics and traumatology, Sakarya education and research hospital, 54100 Sakarya, Turquie
^b Department of orthopedics and traumatology, M.S. Baltalimani bone diseases training and research hospital, 34470 Istanbul, Turquie
^c Liv Hospital, 34100 Istanbul, Turquie
^d Department of orthopedics and traumatology, Istanbul research hospital, 34050 Istanbul, Turquie

^⁎Auteur correspondant.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Friday 21 July 2017
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Abstract

Background

Pilon variant posterior malleolar (PVPM) fractures significantly disrupt joint congruency and cause tibiotalar instability. They are often underestimated and inadequately treated.

Purpose

This study assessed the outcomes of surgical treatment of this subtype of malleolar fracture, and examined the importance of computed tomography (CT) in diagnosis and surgical treatment.

Material and methods

CT images and radiographs of 67 patients with trimalleolar ankle fractures were retrospectively analyzed. Fourteen patients (6 women and 8 men) were studied. The mean age was 37.7 (range, 21–58) years, and mean follow-up period was 17.1 (range, 12–24) months. All patients underwent open reduction. Reconstruction of the joint surface was assessed with postoperative CT images. The outcomes were assessed with the American Academy of Orthopaedic Surgeons (AAOS) and Osteoarthritis (OA) scoring systems.

Results

The ratio of pilon variant posterior malleolar fractures to trimalleolar ankle fractures was 20.1%. Postoperative CT images demonstrated that anatomic reconstruction was achieved in 11 patients. The mean AAOS scores were 85.6 in Type 1 and 81.1 in Type 2 cases. The mean OA scores were 1 in Type 1 and 1.1 in Type 2 cases (P>0.05). The only statistically significant difference between the 2 groups was in osteochondral impaction (P<0.05).

Conclusion

CT imaging is essential for the accurate diagnosis and management of PVPM fractures. Posteromedial and posterolateral incisions enable direct exposure, and therefore facilitate joint surface reconstruction.

Level of evidence

Level IV – retrospective study.

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Keywords : Pilon variant, Posterior malleolus, Computed tomography

☆	Cet article peut être consulté in extenso dans la version anglaise de la revue Orthopaedics & Traumatology: Surgery & Research sur Science Direct (sciencedirect.com) en utilisant le DOI ci-dessus.