骨科英文书籍精读（376）｜Pilon骨折的治疗
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Treatment
The three points of early management of these injuries are: span, scan, plan. Staged treatment has reduced the complication rate in these injuries.
Control of soft tissue swelling is a priority; this is best achieved either by elevation and applying an external fixator across the ankle joint (the spanning external fixator, or travelling traction). It may take 2–3 weeks before the soft tissues improve, and fracture blisters can be actively managed rather than hidden under plaster. Surgery can be planned, based on the CT scan.
Once the skin has recovered, an open reduction and fixation with plates and screws (usually with bone grafting) may be possible. However, the more severe injuries (types 2 and 3) do not readily tolerate large surgical exposures for plating and significant wound breakdown and infection rates have been reported. Better results have followed wider use of indirect reduction techniques (e.g. applying a bone distractor or utilizing the spanning fixator across the joint to obtain as much reduction as possible through ligamentotaxis) and plating through limited exposures. Recently, these injuries have been successfully treated by using a combination of indirect reduction methods and small screws to hold the articular fragments, coupled with axially stable locking plates. Circular frame fixation has also been successful.
The soft-tissue swelling following these injuries is substantial. After fixation, elevation and early movement help to reduce the oedema; arterio-venous impulse devices applied to the sole of the foot are also helpful.
Outcome
Pilon fractures usually take several months to heal. Postoperatively, physiotherapy is focused on joint movement and reduction of swelling. There remains, however, a challenging problem with poor functional results in these complex fractures, which represent a significant soft tissue injury as well as bony jigsaw. Although bony union may be achieved, the fate of the joint is decided by the degree of cartilage injury – the 'invisible’ factor on x-rays. Secondary osteoarthritis, stiffness and pain are still frequent late complications.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
utilizing /ˈjuːtəlaɪzɪŋ/v. 利用（utilize的ing形式）
ligamentotaxy通过韧带整复
Circular frame fixation 圆形框架固定
substantial/səbˈstænʃl/adj. 大量的；实质的；内容充实的n. 本质；重要材料
the sole of the foot 脚底
sole/soʊl/adj. 唯一的；（个人、集体）专有的；（尤指女性）未婚的；单独的n. 脚底；鞋底
Secondary osteoarthritis继发性骨性关节炎
有道翻译（仅供参考，建议自己翻译）：
治疗
早期处理这些损伤的三个要点是：范围、扫描、计划。分期治疗降低了这些损伤的并发症发生率。
控制软组织肿胀是当务之急；最好的方法是抬高并在踝关节上应用外固定器（跨越式外固定器或移动牵引）。软组织改善可能需要2-3周，骨折水泡可以积极处理，而不是隐藏在石膏下。根据CT扫描，可以计划手术。
一旦皮肤恢复，可以切开复位，用钢板和螺钉固定（通常是植骨）。然而，较严重的损伤（2型和3型）不容易耐受大的电镀手术暴露，并且据报道有明显的伤口破裂和感染率。随着间接复位技术的广泛应用（例如，应用骨牵引器或利用跨越固定器穿过关节，通过颏韧带获得尽可能多的复位）和有限暴露的钢板，取得了更好的结果。近年来，通过采用间接复位法和小螺钉固定关节碎片，加上轴向稳定的锁定钢板，成功地治疗了这些损伤。圆形框架固定也取得了成功。
这些损伤后的软组织肿胀很严重。固定后，抬高和早期活动有助于减轻水肿；应用于脚底的动静脉脉冲装置也有帮助。
结果
皮隆骨折通常需要几个月才能愈合。术后，物理治疗的重点是关节运动和减少肿胀。然而，在这些复杂的骨折中仍然存在着一个具有挑战性的问题，即功能效果差，这是一种严重的软组织损伤和骨性拼图。虽然可以实现骨性愈合，但关节的命运取决于软骨损伤的程度——x光片上的“隐形”因素。继发性骨关节炎、僵硬和疼痛仍然是常见的晚期并发症。