Does surgical approach affect sagittal plane alignment and pilon fracture outcomes?
| Autor: | Andrew J. Polk, Brett D. Crist, John M. Weldy, Trevor R. Gulbrandsen, Clay A. Spitler, Robert M. Hulick, Kathryn L. Howell |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male Adolescent Demographics Radiography medicine.medical_treatment Ankle Fractures Pilon fracture Fracture Fixation Internal Young Adult 03 medical and health sciences 0302 clinical medicine Humans Medicine Reduction (orthopedic surgery) Aged Retrospective Studies General Environmental Science Aged 80 and over Orthodontics 030222 orthopedics Surgical approach business.industry Soft tissue 030208 emergency & critical care medicine Bone Malalignment Middle Aged medicine.disease Distal tibia Sagittal plane Tibial Fractures Treatment Outcome medicine.anatomical_structure General Earth and Planetary Sciences Female business Bone Plates |
| Zdroj: | Injury. 51:750-758 |
| ISSN: | 0020-1383 |
| DOI: | 10.1016/j.injury.2020.01.020 |
| Popis: | Purpose Sagittal plane alignment beyond articular reduction and its effect on clinical outcomes has not been emphasized. Surgical approach may influence a surgeon's ability to correct the sagittal plane alignment. The purpose of our study was to evaluate how surgical approach impacts anterior distal tibial angle (ADTA) and lateral talar station (LTS). Our hypothesis was that the anterolateral (AL) approach would improve the sagittal plane parameters due to the primary plate placement. Patients and methods A retrospective review was performed on patients who underwent operative management for pilon fractures at 2 ACS Level 1 Academic Trauma Centers. Clinical data points including demographics, comorbidities, AO/OTA classification, surgical approach, and complications were recorded. Quality of reduction was measured using the ADTA, lateral distal tibia angle (LDTA), and lateral talar station (LTS) from radiographs. Results 580 pilon fractures met inclusion criteria. When compared to the AL approach, the modified anteromedial (AM) approach had decreased rates of local wound care, and unplanned reoperations. The AM approach had increased rates of superficial infection, deep infection, non-union, and amputations. There was no difference in ADTA, LDTA, or LTS between the AM and AL approach (P = 0.49, P = 0.41, P = 0.85). There was a difference in LTS with tobacco users (P = 0.02). Conclusions The sagittal plane alignment does not appear to be affected by the surgical approach. Therefore, the surgical approach to pilon fractures should be based on the fracture pattern and the patient's soft tissue envelope. This study shows that the AM is a relatively safe and effective approach to complex fractures and the surgeon should consider the specific fracture pattern and patient soft tissue envelope when choosing the specific approach. |
| Databáze: | OpenAIRE |
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