Author/Editor     Andoljšek, Matej
Title     Zapleti pri pilon-zlomih golenice: ali vplivajo na izid zdravljenja
Translated title     Complications in pilon-fractures of the tibia: do they influence the outcome of treatment
Type     članek
Source     Zdrav Vestn
Vol. and No.     Letnik 74, št. 6
Publication year     2005
Volume     str. 351-8
Language     slo
Abstract     Background. The pilon fracture of the tibia carries a high risk of complications. In retrospective study the author asked, whether and which complications have influenced the outcome after operative treatment of pilon fractures. Methods. From 1990 to 1996 thirty pilon fractures of the distal tibia were operated in General Hospital Jesenice, Slovenia. Nineteen fractures (63%) were displaced intraarticular (AO/ASIF: 43-B2, C1 and C2; Type II according to Ruedi and Allgower), eleven fractures (37%) had intraarticular comminution (AO/ASIF:43-B3 in C3; Type III). Eight fractures were open (27%). Eleven fractures were treated with minimal osteosynthesis (in five external fixator was added) and nineteen with plate fixation. Thirteen fractures were operated urgently (in first eight hours after injury). Among seventeen delayed treated fractures only two operations were delayed for seven days or more. Fourteen cases had at least one complication (secondary dislocation 2x, deep vein thrombosis 1x, toe contracture 1x, wound edge necrosis 2x, superficial infection 5x, osteitis/osteoarthritis 3x). Pain, range of motion and arthritic changes were evaluated at follow up. The worst of the factors determined the result of treatment. Results. Twenty-eight patients were evaluated on average five years after injury (25-102 months). Four patients have excellent, fourteen good, three fair and seven poor result. Stratified statistical analysis showed that type of fracture was the risk factor of unsuccessful outcome. Fractures with intraarticular comminution (Type III) have significantly worse results. (Abstract truncated at 2000 characters)
Summary     Izhodišča. Zdravljenje pilon-zlomov golenice pogosto spremljajo zapleti. V retrospektivni študiji je avtorja zanimalo, ali zapleti pomembno vplivajo na izid operativnega zdravljenja pilon-zlomov golenice in kateri. Metode. V letih od 1990 do 1996 so na kirurškem oddelku Splošne bolnišnice Jesenice operativno zdravili trideset pilon-zlomov golenice. Devetnajst (63%) je bilo dislociranih intraartikularnih (AO/ASIF: 43-B2, C1 in C2; tip II po Ruediju in Allgowerju), enajst (37%) dislociranih intraartikularnih s sklepno kominucijo (AO/ASIF: 43-B3 in C3; tip III). Osem zlomov je bilo odprtih (27%). Enajst zlomov so oskrbeli z minimalno osteosintezo (petkrat dodan zunanji fiksator), devetnajst zlomov s ploščo in vijaki. Trinajst zlomov so operirali urgentno, ostale odloženo. Štirinajst od tridesetih operiranih pilon-zlomov golenice so spremljali zapleti (sekundarna dislokacija 2-krat, venska tromboza 1-krat, kontraktura palca 1-krat, robne nekroze kože 2-krat, površinska okužba 5-krat, osteoartritis 3-krat). Rezultati zdravljenja so bili ocenjeni na podlagi bolečine, gibljivosti gležnja in prisotnosti artroze. Najslabši med ocenjenimi dejavniki je določil rezultat zdravljenja. Rezultati. Osemindvajset poškodovancev je bilo ocenjenih v povprečju pet let po poškodbi (25-102 meseca). Štirje poškodovanci imajo odličen, štirinajst dober, trije zadovoljiv in sedem slab rezultat zdravljenja. Stratificirana statistična analiza je kot kritični dejavnik neuspelega zdravljenja (zadovoljiv ali slab rezultat) izluščila tip zloma. Zlomi s sklepno kominucijo (tip III) imajo pomembno slabše rezultate. Analiza poškodovancev z zapleti je kot drugi kritični dejavnik izluščila osteitis oz. osteoartritis. (Izvleček skrajšan pri 2000 znakih)
Descriptors     TIBIAL FRACTURES
ANKLE INJURIES
FRACTURES, COMMINUTED
FRACTURES, OPEN
POSTOPERATIVE COMPLICATIONS
TREATMENT OUTCOME
OSTEOARTHRITIS
RETROSPECTIVE STUDIES