Minimal traumatisierende Versorgung der Pilon-tibiale-Frakturen

Abstract Between October 1993 and September 1999a total of 62 pilon-tibiale fractures in 59 pa-tients were treated at the Clinic for Traumaand Reconstructive Surgery,University Hospi-tal Carl-Gustav-Carus,Technical UniversityDresden.In a retrospective study 49 patientswith 50 pilon-tibiale fractures (81%) could beexamined clinically and radiographically anaverage after 28 months after injury.The pur-pose of this study was to compare the healingresults clinically and radiographically by usingthe Ilizarov-technique in combination with aminimalinvasive,internal fixation (group I)with those by using a conventional surgicalprocedure (internal fixation with a plate,ex-ternal fixation with or without minimalinva-sive,internal fixation and screw fixation ex-clusively / group II) and to evaluate the signif-icance of the Ilizarov-technique.Data analysisshowed a significantly increased incidence of43-C2/C3-fractures in the Ilizarov-group I(73%) than in group II (33.3%).Severe softtissue injuries and particularly open injurieshad a significantly increased incidence in theIlizarov-group I (100%) than in the group II(38%).Despite of the high incidence of C2-,C3-fractures and severe soft tissue injuries inthe group I there was no incidence ofpseudoarthrosis or osteitis in the furthercourse and there was no need of an arthrode-sis during the long-term course.After therapywith a conventional surgical technique the in-cidence of an osteitis was 5% and of a de-layed union of fracture 2.5% and an arthrode-sis was necessary at 8%.A disadvantage ofthe Ilizarov-system was the relatively fre-quent incidence of pin-infection (45%) withthe necessity of surgical debridement at 18%.Correspondingly the surgical outcome of 82%of group I-patients and only 51% of group II-patients was rated very well or well.The effi-ciancy of the treatment of 43-C2-,C3-frac-tures with the Ilizarov-technique was obviousby tia statistically,significantly better Mary-land-Foot-Score in comparison with thegroup II.More than 87% of the patients treat-ed with the Ilizarov-technique and only 38%of the patients treated with a conventionalsurgical procedure obtained a very good orgood score.According to these findings theIlizarov-technique in combination with aminimal-invasive,internal fixation is an effec-35]. Eine erhohte Infektions- und Ar-throserate nach offener Reposition undPlattenosteosynthese durften folglichbei Hochrasanztraumen [4, 6, 10, 11,13, 19, 23, 24, 35] auf die, zusatzlich zu dem initial bestehenden traumatischenWeichteilschaden, o perativ bedingteWe ichteildissektion zuruckzufuhren sein.Die beobachteten