[Therapeutic procedure and long-term results in tibial pilon fracture in relation to primary soft tissue damage]. / Therapeutisches Vorgehen und Langzeitergebnisse bei der Pilonfraktur in Abhängigkeit vom primären Weichteilschaden.

Between 1980 and 1990, 81 fractures of the pilon tibial of type B or C in the AO classification, presenting in 78 patients, were treated operatively in the Department of Traumatology and Emergency Surgery of the University Hospitals of Leuven. One-fourth of the fractures were open, 36 had second- or third-degree soft tissue damage according to the Tscherne classification system. The relationship between the fracture type and soft tissue damage was significant: the more severe the soft tissue damage, the more complex the fracture type. Screw osteosynthesis was performed mostly in fractures without soft tissue damage; plate osteosynthesis was used more frequently than external fixation in fractures with severe soft tissue damage. The number of late complications was much higher when the fracture was combined with severe soft tissue lesions. The number of secondary operative procedures on the soft tissue and bones was especially elevated in fractures primarily stabilized with a plate osteosynthesis. Sixty-four patients were reviewed clinically and radiologically after a mean time of 52.7 months. The subjective and objective end results were classified in accordance to the scales of Ovadia. Of the patients without soft tissue lesions, 86.4% showed excellent or good subjective and 74.6% excellent or good objective end results; 55.6% of the patients with severe soft tissue damage had excellent or good subjective and 48.1% excellent or good objective end results. In pilon fractures with severe soft tissue damage, bony consolidation can only be reached after several operative steps. In the primary procedure, only minimal osteosynthesis, combined with medial external fixation should be performed.(ABSTRACT TRUNCATED AT 250 WORDS)

Surgical management of pelvic ring disruptions. Indications, techniques and functional results.

In a period of 30 months, we treated 44 pelvic ring fractures by early operative stabilization. The ratio of associated musculoskeletal and intrapelvic lesions was very high, with a mean ISS of 36.2. The perioperative mortality rate (3/44) was acceptable with 6.8%. A second osteosynthesis was performed in fast 8% of type-B and in fast 40% of type-C lesions. The average hospital stay was very short with 42.0 days. We were able to mobilize the patients very early after their admission, thanks to the quick operative stabilization of the pelvic ring and the other skeletal injuries. Of the 39 surviving patients, 35 were reviewed clinically, functionally and radiographically after a mean of 19.3 months. There was a statistically significant difference in the rate of walking difficulties, walking distance, hip mobility, muscle force and the functional end-results between patients with type-B and those with type-C lesions. Lesions of type B are benign and can be adequately treated by the application of an anterior external fixator frame alone. The functional results are excellent or good in the great majority of cases. The type-C lesions are much more difficult to deal with. The anterior external fixator provides insufficient stability in many cases. It must be supplemented by posterior fixation or exchanged for anterior and posterior internal fixation. Even then, many patients with type-C lesions have functional disabilities and subjective complaints after treatment.