Visualizing access in pilon fractures: A comparative study of eight approaches.

IF 1.9 3区医学 Q2 ORTHOPEDICS

Foot and Ankle Surgery Pub Date : 2025-02-26 DOI:10.1016/j.fas.2025.02.009

Tomas Urrutia, Jorge Faundez, Catalina Vidal, Joaquín Palma, Jorge Filippi

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引用次数: 0

Abstract

Background: Pilon fractures, constituting 3-10 % of all tibia fractures, present significant challenges due to their complex nature and frequent involvement of soft tissue damage. Effective management necessitates careful preoperative planning and strategic surgical approach selection. This study aims to provide a comprehensive cadaveric analysis comparing eight distinct surgical approaches to tibial pilon fractures, focusing on the consistently exposed segment and the extent of the exposed bone area for each approach.

Methods: Sixteen foot and ankle specimens, obtained through our university's body donation program, were utilized for this study. Each specimen underwent two different approaches, resulting in four repetitions for each assessed method. The approaches analyzed included anteromedial, anterolateral, lateral, posterolateral, posteromedial, posterior modified posteromedial, anterior modified posteromedial, and medial approaches. Standardized incisions and retraction techniques were employed to measure the exposed bone area using ImageJ software, while the consistently exposed segment was determined through axial cuts and photographic analysis.

Results: The anteromedial approach yielded the largest exposed area (18.36 cm²), whereas the anterolateral approach provided the greatest exposed segment (72°). The posteromedial approach proved most effective for exposing the Volkmann fragment, and the anterolateral approach was optimal for accessing the Chaput fragment and comminution areas. Combining the posteromedial and posterior modified posteromedial approaches could be suggested for extensive posterior malleolus fractures to maximize bone surface exposure while minimizing soft tissue damage.

Conclusion: This study offers objective data on the exposed area and segment for various surgical approaches, providing a valuable resource for orthopedic surgeons in preoperative planning and decision-making. By enhancing the understanding of the capabilities and limitations of each approach, this research aims to improve surgical outcomes for patients with complex tibial pilon fractures.

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枕部骨折的可视化通路：八种入路的比较研究。

背景：皮隆骨折，占所有胫骨骨折的3- 10% %，由于其复杂的性质和频繁涉及软组织损伤，提出了重大挑战。有效的治疗需要仔细的术前计划和策略性的手术入路选择。本研究旨在提供全面的尸体分析，比较8种不同的手术入路治疗胫骨pilon骨折，重点关注每种入路的持续暴露段和暴露骨面积的程度。方法：利用我校遗体捐献项目获得的16例足部和踝关节标本进行研究。每个标本经历了两种不同的方法，导致每种评估方法重复四次。分析的入路包括前内侧入路、前外侧入路、外侧入路、后外侧入路、后内侧入路、后内侧入路、前内侧入路和内侧入路。使用ImageJ软件采用标准化切口和内收技术测量暴露骨面积，通过轴向切口和摄影分析确定一致暴露的骨段。结果：前内侧入路暴露面积最大（18.36 cm²），前外侧入路暴露面积最大（72°）。后内侧入路对于暴露Volkmann碎片最为有效，而前外侧入路对于接触Chaput碎片和粉碎区最为理想。后内侧入路和后路改良后内侧入路联合应用于广泛后踝骨折，可最大限度地暴露骨面，同时减少软组织损伤。结论：本研究为各种手术入路的暴露区域和暴露段提供了客观的数据，为骨科医生的术前规划和决策提供了宝贵的资源。通过加深对每种入路的能力和局限性的了解，本研究旨在改善复杂胫骨pilon骨折患者的手术效果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Foot and Ankle Surgery ORTHOPEDICS-

CiteScore

4.60

自引率

16.00%

发文量

202

期刊介绍： Foot and Ankle Surgery is essential reading for everyone interested in the foot and ankle and its disorders. The approach is broad and includes all aspects of the subject from basic science to clinical management. Problems of both children and adults are included, as is trauma and chronic disease. Foot and Ankle Surgery is the official journal of European Foot and Ankle Society. The aims of this journal are to promote the art and science of ankle and foot surgery, to publish peer-reviewed research articles, to provide regular reviews by acknowledged experts on common problems, and to provide a forum for discussion with letters to the Editors. Reviews of books are also published. Papers are invited for possible publication in Foot and Ankle Surgery on the understanding that the material has not been published elsewhere or accepted for publication in another journal and does not infringe prior copyright.