Therapeutic difficulties in tibial pylon fractures
March 31, 2010
| Abstract Title: | Therapeutic difficulties in tibial pylon fractures |
| Authors: | Dan Fruja, Alexandru Pop |
| Affiliation: | “Vasile Goldis” Western University Arad, Romania Orthopaedic Department, Emergency Clinical County Hospital Arad, Romania |
| Abstract text: | Background: Tibial pylon fractures are considered severe injuries because of elevated risk of complications. Clinical judgment of the condition of the soft tissues is the critical point in the management of these fractures; delay between injury and definitive ORIF (from 7 to 24 days), with provisional use a bridging external fixator is the standard of care of these fractures. In the last decade, development of true minimally invasive techniques (MIPO) has improved the surgical treatment of these challenging injuries. Objectives: to evaluate the early results after ORIF (open reduction and internal fixation) of the 18 tibial pylon fractures (type C – according to AO classification), which had treated in Orthopedic Department of the County Hospital Arad in the last 5 years. Material and methods: the mean delay period between injury and surgery was 14 days; for provisional stabilization, we had utilized an external fixator in 6 cases and a skeletal traction in 12 cases. The definitive management had included a limited internal fixation (with K. wires) in 4 cases, fixation of the fibula with one-third tubular plate in association with tibial fixation with screws (in 12 cases) and fixation of tibial fracture with anatomically-contoured plates (in 2 cases). We don’t have experience with MIPO techniques, because of expensive costs of these methods. Results: we had a 4 skin necrosis after surgery (which had necessitated further debridement of the wounds, with subsequent skin grafts), 2 superficial infection of the surgical wounds (which has healed after further debridement and antibiotic administration) and 1 deep infection (septic osteoarthritis)-which has necessitated amputation. Conclusions: the management of the fractures of the tibial pylon, although careful attention of soft tissues and well-performed surgery, may still result in a poor outcome, due to primary soft tissue damage before surgery and general and local conditions of the patients. |
| Keywords: | tibial pylon fractures, provisional stabilization, delayed definitive fixation |
| Presentation type: | Oral |
| Correspondence: | no. 25 Dorel Sibii St., Arad, Romania |
| Email: | frujad@yahoo.com |
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