Discussion questions in surgical treatment of pilon fractures
One of the features of the modern development of traumatology is the widespread use of internal osteosynthesis technologies, and the developments of the AO have already acquired global significance. But for a number of objective reasons, this process has not only positive, but also negative consequences. A large number of early infectious complications and late disturbances of regeneration is associated with a significant injury rate in open repositioning of bone fragments and osteosynthesis (intraosseous), when damage due to a surgical trauma puts soft tissues on the brink of survival. This is particularly noticeable in the high-energy trauma of the distal tibia (pilon), where complications reach about 54 %. The advantages of internal osteosynthesis can be realized only when anatomic repositioning and reliable fixation of bone fragments are achieved, which eliminates the need for additional immobilization providing early functional treatment without the risk of secondary dislocation. However, such results with pylon injuries (in particular, with multifragmentary impression fractures of the distal tibia) can not be achieved technically using bone osteosynthesis. These situations should be predicted at the stage of preoperative planning, and surgical decisions to be made, since the controversial outcome of internal fixation does not justify the high risk of complications and significant logistical efforts. An alternative to external osteosynthesis to a large extent may be external osteosynthesis, which is universal, minimally invasive, consistent with biological principles and, therefore, doesn’t cause severe irreversible complications. The relative limitations of the repositioning capabilities of these technologies can be largely achieved by functional remodeling of joint surfaces based on the use of modern methods of functional orthosis. The goal is to increase the efficiency and to reduce the number of complications of surgical treatment in pilon fractures using physiological, minimally invasive technologies. The material of the work is analysis of treatment outcomes in open and closed pylon trauma of all the main types in 42 patients of both sexes and different age groups. Preoperative planning and subsequent surgical treatment depended on the presence or absence of an open wound, the results of a distraction X-ray test, the nature of damage to the fibula. The main method of fixation was external osteosynthesis with single-sided rod devices of various types used in the necessary schemes of mounting. Following therapy, 31 % of excellent, 36 % of good, 28 % of satisfactory and 5 % of unsatisfactory results were obtained. Treatment outcomes indicate the reliability of this technology for the prevention of severe disabling complications due to its compliance with biological principles.
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