足と足首の臨床研究

抽象的な

Endoscopic Guided Tibiotalocalcaneal Arthrodesis After Failed Osteosynthesis of Pilon Fractures

Frederick Michels, Arne Burssens, Guy Putzeys, Jan Van Der Bauwhede and Stéphane Guillo

Pilon fractures are difficult to treat because of the fracture pattern and are usually associated with significant soft tissue injury, which may result in a series of complications. Patients with diabetes and sensory neuropathy are at even greater risk of fixation failure, skin flap necrosis and deep infection. Treatment of complicated situations in patients is even more challenging and often results in an amputation. We describe a surgical treatment in two steps. First, we recommend an aggressive debridement to eradicate infection. After recovery of soft tissues, hindfoot fusion with a retrograde intramedullary nail helps to obtain a stable fixation. The removal of the cartilage can be performed endoscopically. This minimizes new soft tissue damage and favours wound healing. This treatment provides the patient with a pain-free plantigrade foot for ambulation.