Staged Procedure Protocol Based on the Four-column Concept in the Treatment of AO/OTA Type 43-C3.3 Pilon Fractures

Overview

Journal J Int Med Res

Publisher Sage Publications

Specialty General Medicine

Date 2019 Mar 21

PMID 30890008

Citations 9

Authors

Hui Chen

Xueliang Cui

Binbin Ma

Yunfeng Rui

He Li

Affiliations

Soon will be listed here.

Abstract

Objective: We herein introduce a staged management protocol for AO/OTA type 43-C3.3 pilon fractures based on the four-column theory designed to protect the soft tissue.

Methods: Twenty-three patients with 25 type C3.3 pilon fractures underwent a staged procedure with four-column osteosynthesis from April 2014 to December 2016. The first stage involved immediate calcaneal traction or external fixation to span the ankle joint. When the soft tissue swelling decreased, the posterolateral approach was used to restore the lateral column and initially fix the posterior column. After 10 to 12 days, the third stage involved treatment of the anterior and medial columns through the anterior approach. Charts and radiographs were reviewed, and the American Orthopaedic Foot and Ankle Society (AOFAS) evaluation system was used to evaluate the postoperative outcomes.

Results: All fractures achieved union after a mean of 3.3 months (range, 2.0-5.7 months) after the third stage. A good or acceptable reduction rate was observed in 85.7% of the patients. Results from the AOFAS evaluation system indicated excellent or good postoperative ankle function in 81.0% of the patients.

Conclusion: This staged procedure protocol combined with the four-column theory is a feasible way to protect the soft tissue and reduce the fracture.

Citing Articles

Development and validation of the nomogram of high fascial compartment pressure with pilon fracture.

Hu X, Wang P, Li C, Liu L, Wang X, Jin L Int Orthop. 2025; 49(2):503-513.

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Use of Three-dimensional Printing for Tibial Pilon Fracture Diagnosis and Treatment.

Wustro L, Silva J, Moura B, Schoenberger H, Takito D, Honorio DAgostini J Rev Bras Ortop (Sao Paulo). 2024; 59(3):e456-e461.

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Three-Dimensional Heat Map: The OTA/AO Type 43C Pilon Fracture Lines Distribution.

Gao Y, Zhao Y, Wang H, Xu X, Cheng Z, Lu T Int J Gen Med. 2024; 17:323-334.

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Treatment strategies for complex ankle fractures-current developments summarized in a narrative review.

Mair O, Pfluger P, Hanschen M, Biberthaler P, Cronlein M Ann Transl Med. 2023; 11(11):387.

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Risk factors and nomogram predictive model of surgical site infection in closed pilon fractures.

Ke C, Dong X, Xiang G, Zhu J J Orthop Surg Res. 2023; 18(1):582.

PMID: 37553679 PMC: 10408134. DOI: 10.1186/s13018-023-04058-z.

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