신연 외고정 및 지속적 반수동 운동을 이용한 경골 원위부 필론 골절의 치료
Continuous Half Passive Motion under Distracted External Fixation for the Treatment of Distal Tibial Pilon Fractures
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Purpose: Pilon fracture has several serious complications such as joint stiffness, arthrosis and delayed angular deformity. We report short-term results of new treatment modality using distracted dynamic external fixators and early controlled ankle motion. Materials and Methods: Eight cases of severe pilon fractures for which we tried small plate fixation and additional distracted dynamic external fixators from July 2007 to June 2009 were included. Half passive continuous ankle joint motion was allowed under free hinged ring fixators after the operation. The external fixators were removed after two or three months from the surgery. We investigated joint space by radiograph, joint pain, range of motion, patient’s satisfaction of treatment protocol. Results: Joints were distracted when external fixators were applied and mean 28% of space loss developed after removal of external fixators. In most of cases, satisfactory alignments were maintained. Regarding range of joint motion, mean dorsiflexion angle was 15 degrees and mean plantarflexion angle was 32 degree in the condition of wearing external fixators. There was mean 8%reduction of range of motion but no further progression of ankle stiffness after removal of external fixators. Dorsiflexion was not improved after that, but plantarflexion angle was improved 10% even after removal of external fixators. Patients were generally in compliance with the treatment protocols with high level of satisfaction. Conclusion: We got good results with distracted dynamic external fixators and early continuous half-passive joint motion for pilon fractures in terms of joint pain and range of motion. Therefore we suggest this new protocol as an alternative modality for severe pilon fractures.
Abstract
Purpose: Pilon fracture has several serious complications such as joint stiffness, arthrosis and delayed angular deformity. We report short-term results of new treatment modality using distracted dynamic external fixators and early controlled ankle motion. Materials and Methods: Eight cases of severe pilon fractures for which we tried small plate fixation and additional distracted dynamic external fixators from July 2007 to June 2009 were included. Half passive continuous ankle joint motion was allowed under free hinged ring fixators after the operation. The external fixators were removed after two or three months from the surgery. We investigated joint space by radiograph, joint pain, range of motion, patient’s satisfaction of treatment protocol. Results: Joints were distracted when external fixators were applied and mean 28% of space loss developed after removal of external fixators. In most of cases, satisfactory alignments were maintained. Regarding range of joint motion, mean dorsiflexion angle was 15 degrees and mean plantarflexion angle was 32 degree in the condition of wearing external fixators. There was mean 8%reduction of range of motion but no further progression of ankle stiffness after removal of external fixators. Dorsiflexion was not improved after that, but plantarflexion angle was improved 10% even after removal of external fixators. Patients were generally in compliance with the treatment protocols with high level of satisfaction. Conclusion: We got good results with distracted dynamic external fixators and early continuous half-passive joint motion for pilon fractures in terms of joint pain and range of motion. Therefore we suggest this new protocol as an alternative modality for severe pilon fractures.
참고문헌 (23)
- McFerran MA, "Complications encountered in the treatment of Pilon fractures", J Trauma, 6, pp.195~200 (1992)
- Teeny SM, "Open reduction and internal fixation of tibial plafond fractures. Variables contributing to poor results and complications", Clin Orthop Relat Res, 292, pp.108~117 (1993)
- Blauth M, "Surgical options for the treatment of severe tibial pilon fracture: a study of three techniques", J Orthop Trauma, 15, pp.153~160 (2001)
- Ruedi TP, "The operative treatment of intraarticular fractures of the lower end of the tibia", Clin Orthop Relat Res, 138, pp.105~110 (1979)
- Kang CS, "A clinical study of the surgical treatment of pilon fracture", J Korean Orthop Assoc, 28, pp.276~290 (1993)
- Karas EH, "Displaced pilon fractures. An update", Orthop Clin North Am, 25, pp.651~663 (1994)
- Mast JW, "Fractures of the tibial pilon", Clin Orthop Relat Res, 230, pp.68~82 (1988)
- Bourne RB, "Intraarticular fractures of the distal tibia: the pilon fracture", J Trauma, 23, pp.591~596 (1983)
- Kellam JF, "Fractures of the distal tibial metaphysic with intra-articular extension: the distal tibial explosion fracture", J Trauma, 19, pp.593~601 (1979)
- Kim HS, "Treatment of tibial pilon fractures using ring fixators and arthroscopy", J Korean Orthop Assoc, 30, pp.1538~1545 (1995)
- Ovadia DN, "Fractures of the tibial plafond", J Bone Joint Surg Am, 68, pp.543~551 (1986)
- Murler ME, "Manual of internal fixation technique recommended by the AO group. 2ndEd", pp.278~281 (1979), Springer-Verlag
- Pugh KJ, "Tibial plafond. A comparison of treatment methods", J Trauma, 47, pp.937~941 (1999)
- Bone L, "External fixation of severely comminuted and open tibial pilon fracture", Clin Orthop Relat Res, 292, pp.101~107 (1993)
- Salter RB, "The biologic effect of continuous passive motionon the healing of full thickness defects in articular cartilage. An experimental investigation in the rabbit", J Bone Joint Surg Am, 62, pp.1232~1251 (1980)
- Morse KR, "Distraction arthroplasty", Foot Ankle Clin, 12, pp.29~39 (2007)
- Paley D, "Distraction arthroplasty of the ankle-how far can you stretch the indications", Foot Ankle Clin, 13, pp.471~484 (2008)
- Tellisi N, "Joint preservation of the osteoarthritic ankle using distraction arthroplasty", Foot Ankle Int, 30, pp.318~325 (2009)
- Bottlang M, "Articulated external fixation of the ankle: minimizing motion resistance by accurate axis alignment", J Biomech, 32, pp.63~70 (1999)
- DiChristina D, "Pilon fracture treated with an articulated external fixator. A preliminary report", Orthopaedics, 19, pp.1019~1024 (1996)
- Fitzpatrick DC, "Articulated external fixation of pilon fractures: the effects on ankle joint fragment kinematics", J Orthop Trauma, 9, pp.76~82 (1995)
- Marsh JL, "Use of an articulated external fixator for fractures of the tibial plafond", J Bone Joint Surg Am, 77, pp.1498~1509 (1995)
- Mitkovic MB, "Dynamic external fixation of comminuted intra-articular fractures of the distal tibia (type C pilon fractures)", Acta Orthop Belg, 68, pp.508~514 (2002)