Surgical correction of distal tibia posttraumatic deflection

Authors

  • I. I. Trufanov State Institution “Zaporizhzhia Medical Academy of Post-Graduate Education Ministry of Health of Ukraine”,
  • Ye. A. Pobiel State Institution “Zaporizhzhia Medical Academy of Post-Graduate Education Ministry of Health of Ukraine”,
  • V. V. Kosylo State Institution “Zaporizhzhia Medical Academy of Post-Graduate Education Ministry of Health of Ukraine”,

DOI:

https://doi.org/10.14739/2310-1210.2018.5.141655

Keywords:

pilon fractures, tibia, arthrosis

Abstract

Objective – to study the issues related to diagnostics and treatment of pilon fracture of the tibial epiphysis and individual approach to surgical correction of posttraumatic deformations of the distal tibia.

Material and methods. The treatment results of 49 patients who had suffered pilon fractures throughout 1–2 years after treatment completion were studied in the clinic of Traumatology and Orthopedic on the basis of “ZSMKH №9”. According to the AO classification patients had the following types of fractures: 43A – 7 patients, 43B – 14 and43C – 28. The X-ray measurements characterizing the geometric shape of articular surfaces were measured. The mathematical finite element method of computer modeling was used for the study of bone and cartilaginous tissues stress distribution pattern in the ankle joint in its normal condition and in case of post-traumatic deflections.

Results. The basic pathological symptom in patients with pilon fractures of distal tibia is joint function limitation, which spreads to the sector of dorsal extension, regardless of the pilon fracture type. The joint continues to function, however movement amplitude is decreased. The most unfavorable change of distal tibia shape is valgus inclination of articular surface. This configuration change of tibial articular end requires repeated surgical correction.

Conclusions. The main task of the distal tibial epiphysis surgical correction is the weight-bearing function and axial relationships restoration and pain management. It can be concluded that selective approach to posttraumatic deformations of the distal tibia surgical correction is essential. The main indications for surgical correction are pseudarthrosis, deviations in the frontal plane of more than 10 degrees, severe joint arthrosis accompanied by pain syndrome for more than a year.

 

References

Slastinin, V. V., Klyukvin, I. Y., Filippov, O. P., & Bogolyubsky, Y. A. (2015). Vnutrisustavnye perelomy distal'nogo otdela bol'sheberсovoо kosti: e'volyuсiya vzglyadov na khirurgicheskoe lechenie (obzor literatury) [Intra-articular fractures of the distal tibia: evolving of views on surgical treatment]. Zhurnal im. N.V. Sklifosofskogo. Neotlozhnaya medicinskaya pomoshch', 3, 23–29 [in Russian].

Trufanov, I. I., & Mirenkov, K. V. (2013). Vidy diskongruentnosti golenostopnogo sustava posle lecheniya perelomov PILON [The Types of Incongruence Ankle Joint Post Treatment of Pilon Fractures]. Litopys travmatolohii ta ortopedii, 1–2, 56–60. [in Russian].

Korzh, N. A., Romanenko, K K., Goridova, L. D., & Prozorovsky, D. V. (2011). Perelomy kostej goleni na urovne distal'nogo e'pimetafiza (perelomy pilon´a) i ikh posledstviya, diagnostika i lechenie [Fractures of Distal Epimetaphysis of Tibia (Pilon Fractures) and Their Consequences, Diagnostics and Treatment]. Travma, 12(2), 6–10. [in Russian].

Tkachuk, N. A., Veretelnik, O. V., & Trufanov, I. I. (2009). Matematicheskoe modelirovanie povedeniya biomekhanicheskoj sistemy pri nagruzhenii [Mathematical modeling of biomechanical system behavior under load]. Visnyk NTU «KhPI». Tematychnyi vypusk «Mashynoznavstvo ta SAPR», 28, 106–127. [in Russian].

de Boer, P., & Metcalfe, R. (2003) Pilon fractures of the tibia. Current Orthopaedics, 17(3), 190–199.

Gulabi, D., Erdem, M., Cecen, G. S., Avci, C. C., Saglam, N., & Saglam, F. (2014) Ilizarov Fixator Combined With an Intramedullary Nail for Tibial Nonunions With Bone Loss: Is It Effective? Clinical Orthopaedics and Related Research, 472(12), 3892–3901. doi: 10.1007/s11999-014-3640-8.

Hulscher, J. B., te Velde, E. A., Schuurman, A. H., Hoogendoorn, J. M., Kon, M., & van der Werken, C. (2001) Arthrodesis after osteosynthesis and infection of the ankle joint. Injury, 32(2), 145–152. doi: 10.1016/S0020-1383(00)00156-X.

Mitkovic, M. B., Bumbasirevic, M. Z., Lesic, A., & Golubovic, Z. (2002) Dynamic external fixation of comminuted intra-articular fractures of the distal tibia (type C pilon fractures). Acta Orthop Belg, 68(5), 508–514.

Tomás-Hernández, J. (2016). High-energy pilon fractures management: State of the art. EFORT Open Reviews, 1(10), 354–361. doi: 10.1302/2058-5241.1.000016.

Mayffrey, C., Vasario, G., Batiston, B., Lewis, C., Beazley, J., & Selicson, D. (2011) Tibial pilon fractures: a review of incidence, diagnosis, treatment, and complication. Acta Orthoped. Belg., 77(4), 432–440.

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How to Cite

1.
Trufanov II, Pobiel YA, Kosylo VV. Surgical correction of distal tibia posttraumatic deflection. Zaporozhye medical journal [Internet]. 2018Sep.24 [cited 2024Apr.19];(5). Available from: http://zmj.zsmu.edu.ua/article/view/141655

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Original research