171,020 research outputs found
Three-Dimensional Heat Map: The OTA/AO Type 43C Pilon Fracture Lines Distribution
No full textYuling Gao,1 Yanrui Zhao,1 Hanzhou Wang,1 Xiaopei Xu,1 Zhexian Cheng,2 Tianchao Lu,1 Yang Liu,1 Junlin Zhou1 1Orthopedics Department, Affiliated Beijing Chaoyang Hospital of Capital Medical University, Bejing, People’s Republic of China; 2Preventive Dentistry Department, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, People’s Republic of ChinaCorrespondence: Junlin Zhou; Yang Liu, Beijing Chaoyang Hospital, Capital Medical University, Gongtinan Road 8#, Beijing, 100020, People’s Republic of China, Email [email protected]; [email protected]: This study aimed to create three-dimensional heat map and study the characteristic of fracture lines and represented fragments of OTA/AO type 43C pilon fractures.Methods: CT scan was performed in105 fractures diagnosed with OTA/AO type 43C pilon fractures between January 2017 and December 2022. Three-dimensional pilon fracture maps were created and converted into fracture heat maps. CT scan graphic parameters including the fracture line height, α angle, β angle, the ratio of the area and size of bone fragment represented by the fracture line to the total articular surface were measured.Results: The study included 105 patients with 91 males and 14 females. The fractures included C1 (n=16), C2 (n=23), and C3 (n=66). There was no statistically different among the most parameters except in the fracture-line height of the anterior fracture line (p=0.03) and the sagittal fracture line (p=0.02) between C2 and C3 pilon fractures. The average size of the anterolateral fragment, occupied approximately 13.5% of the articular surface area, was (11.5± 2.8) mm × (20.5± 6.3) mm with the average height of 29.8 mm. The average size of the posterolateral fragment, occupied approximately 13.0% of the articular surface area, was (15.7± 4.6) mm × (19.3± 4.0) mm with the average height of 19.1 mm.Conclusion: This study demonstrates that the articular surface fracture lines in the C type pilon fracture are formed by fixed main fracture lines. The understand of morphological and distribution characteristics of the fracture lines and size of fragments in OTA/AO type 43C pilon fractures would help the surgeons take suitable approach and fixation.Keywords: pilon fractures, heat map, three-dimensional reconstruction, classificatio
Livres neufs mis au pilon et recyclage, une véritable solution ?
No full textLe pilon, une entreprise polluante. Aujourd’hui, et de manière générale les livres invendus en librairie, les livres ayant des défauts d’impression ou les livres abîmés finissent « au pilon ». Cette expression commune du monde du livre désigne la destruction d’un livre, on utilise ce terme par analogie avec les machines qui servent à pilonner le livre. Lors d’une mise au pilon c’est l’éditeur qui décide de les détruire ou de les garder et en 2020, le Syndicat National des éditeurs (SNE) c..
Osteochondrale Fraktur des lateralen Pilon tibial [=Osteochondral fracture of the lateral tibial pilon]
No full textIn this paper we report a case of osteochondral fracture of the lateral tibial pilon. A young man fell while he was playing soccer. In the following months the ankle was swollen and painful. Later the reason for his ankle pain was clearly visible on the X-ray pictures, which revealed a severe osteochondral fracture of the lateral tibial pilon. We describe the arthroscopic and X-ray grading of osteochondral fractures of the ankle and their treatment
J.-C. Chasteland, J. Véron, M. Barbiéri, eds., Politiques de développement et croissance démographique rapide en Afrique (Actes de la conférence internationale "Développement et croissance démographique rapide : regard sur l'avenir de l'Afrique", Paris, 2-6 septembre 1991).
No full textSchlemmer Bernard, Pilon Marc. J.-C. Chasteland, J. Véron, M. Barbiéri, eds., Politiques de développement et croissance démographique rapide en Afrique (Actes de la conférence internationale "Développement et croissance démographique rapide : regard sur l'avenir de l'Afrique", Paris, 2-6 septembre 1991).. In: Études rurales, n°131-132, 1993. Droit, politique, espace agraire au Brésil. pp. 202-205
Distal tibial pilon fractures (AO/OTA type B, and C) treated with the external skeletal and minimal internal fixation method
No full textBackground/Aim. Distal tibial pilon fractures include extra-articular fractures of the tibial metaphysis and the more severe intra-articular tibial pilon fractures. There is no universal method for treating distal tibial pilon fractures. These fractures are treated by means of open reduction, internal fixation (ORIF) and external skeletal fixation. The high rate of soft-tissue complications associated with primary ORIF of pilon fractures led to the use of external skeletal fixation, with limited internal fixation as an alternative technique for definitive management. The aim of this study was to estimate efficacy of distal tibial pilon fratures treatment using the external skeletal and minimal internal fixation method. Methods. We presented a series of 31 operated patients with tibial pilon fractures. The patients were operated on using the method of external skeletal fixation with a minimal internal fixation. According to the AO/OTA classification, 17 patients had type B fracture and 14 patients type C fractures. The rigid external skeletal fixation was transformed into a dynamic external skeletal fixation 6 weeks post-surgery. Results. This retrospective study involved 31 patients with tibial pilon fractures, average age 41.81 (from 21 to 60) years. The average follow-up was 21.86 (from 12 to 48) months. The percentage of union was 90.32%, nonunion 3.22% and malunion 6.45%. The mean to fracture union was 14 (range 12-20) weeks. There were 4 (12.19%) infections around the pins of the external skeletal fixator and one (3.22%) deep infections. The ankle joint arthrosis as a late complication appeared in 4 (12.90%) patients. All arthroses appeared in patients who had type C fractures. The final functional results based on the AOFAS score were excellent in 51.61%, good in 32.25%, average in 12.90% and bad in 3.22% of the patients. Conclusion. External skeletal fixation and minimal internal fixation of distal tibial pilon fractures is a good method for treating all types of inta-articular pilon fractures. In fractures types B and C dynamic external skeletal fixation allows early mobility in the ankle joint. [Projekat Ministarstva nauke Republike Srbije, br. III41017
A Modified Posteromedial Approach Combined With Extensile Anterior for the Treatment of Complex Tibial Pilon Fractures (AO/OTA 43-C)
No full textThe anterior approaches that have been described for open reduction internal fixation of multifragmentary pilon fractures are designed to reconstruct the comminuted and impacted anterior articular surface onto a stable posterior column. Thus, reduction of the posterior column, particularly proper length, is critical. There are differing opinions of how best to surgically approach the posterior pilon fracture. There is also no clear indication as to the timing of both anterior and posterior reconstructions. Our objectives were (1) to develop a more midline posterior approach that might provide better visualization of the posterior aspect of the posterior column and juxtametaphyseal/diaphyseal parts of the tibia, first on the cadaver and then with patients, and (2) to use this as part of a combined posterior and anterior approach during the same anesthesia for complex tibial pilon fractures (AO/OTA 43-C) in a preliminary study of 6 patients
Emergent hybrid external fixation for tibial pilon fractures in adults
No full textObjective: To investigate that if the hybrid external fixation is the definitive treatment and management of tibial extra articular and intra-articular pilon fractures of the adult in emergency.
Methods: We treated 237 cases of pilon fractures using hybrid external fixation with or without minimal osteosynthesis from February 1999 to December 2014. All fractures were classified according to the Association for the Study of Internal Fixation. The three groups were represented by 108 patients (45.5%) for the Type A; 75 patients (31.8%) for Type B and 54 patients (22.7%) for Type C. Road accidents [118 patients (50.0%)] were the most common cause of tibial pilon fractures.
Results: According to a mean follow-up of 7.3 years we had bone healing after 4.8 months from surgery in the 61.18% of the patients. The results were subjectively excellent, while the 54.00% were objectively excellent according to Ovadia and Beals score, and the results showed 29 complications.
Conlusions: From our data hybrid external fixation with or without minimal fixation is a good surgical method to treat pilon fractures
Pilon-murtumien leikkauskomplikaatiot Turun yliopistollisessa keskussairaalassa vuosina 2018–2022
No full textTämän tutkimuksen tarkoituksena on tutkia Turun yliopistollisessa keskussairaalassa (Tyks) aikavälillä 2018–2022 hoidettujen pilon-murtumien riskitekijöiden ja leikkausmenetelmien vaikutusta komplikaatioiden esiintyvyyteen. Lisäksi tutkimuksessa tutkittiin uusintaleikkausten määriä sekä syitä. Komplikaatioiden syitä tutkimuksessa olivat syvä infektio sekä murtuman asennon pettäminen. Uusintaleikkausten syitä olivat infektio, luutumattomuus sekä levykiinnityksen aiheuttama kipu ja/tai toiminnallinen haitta nilkan funktioon. Komplikaatioon liittyviä tutkimustuloksia vertailtiin kirjallisuuteen.
Tutkimukseen valittiin kaikki Tyksissä aikavälillä 2018–2022 operoidut potilaat, joilla todettiin pilon murtuma. Pilon-murtumiksi hyväksyttiin ne murtumat, joiden morfologia täytti Ruedi-Allgower- sekä AO/OTA-luokituksen B- ja C-luokan murtumien kriteerit. Potilaiden sairauskertomusmerkinnöistä kerättiin tarvittavat tiedot. Murtumien hoitomenetelminä olivat murtuman sisäinen kiinnitys (ORIF), kaksivaiheinen leikkaushoito sekä ulkoisen kiinnityslaitteen (eksterni fiksaattori) käyttö definitiivisenä hoitomenetelmänä.
Tutkimusaineisto sisälsi 44 potilasta. Potilaista 11 % (n=5) todettiin syvä infektio sekä yhdellä potilaalla lisäksi samanaikainen osteosynteesin katkeaminen. Tutkimuksessa infektioriskiin vaikutti tilastollisesti merkitsevästi avomurtuman osallisuus. Sukupuolella, diabeteksella, tupakoinnilla, ASO-taudilla tai alkoholin ongelmakäytöllä ei todettu tilastollisesti merkitsevää vaikutusta infektioriskiin. Myöskään leikkausmenetelmillä ei todettu tilastollisesti merkitsevää vaikutusta infektioriskiin.
Syvien infektioiden esiintyvyys vastasi kirjallisuudessa raportoituja lukuja. Tutkimuksen avomurtumista 44 % (n=4) kehitti syvä infektion. Esiintyvyys oli kirjallisuuteen verrattuna korkeampi. Tätä voi selittää avomurtumien vaikeusaste. Diabetes ja ajankohtainen tupakointi ovat kirjallisuudessa raportoituja riskitekijöitä. Tässä tutkimuksessa niiden ei todettu vaikuttavan tilastollisesti merkitsevästi syvien infektioiden esiintyvyyteen, vaikka syvät infektiot olivat yleisiä kyseisten potilasryhmien kohdalla. Murtumien eri hoitomenetelmillä ei ollut tilastollisesti merkitsevää vaikutusta infektioriskiin.
Tämän tutkimuksen perusteella pilon-murtumien ORIF:n keskeisin tavoite on pyrkiä palauttamaan nilkan alkuperäinen anatomia. Leikkaushoito tulee tehdä mahdollisimman vähäisillä ihoavauksilla, mutta parhaaseen leikkaustulokseen pääsemiseksi käytettyjen ihoavausten tai levykiinnitysten määriä ei tarvitse rajoittaa. Tutkimuksessa avomurtumilla todettiin olevan tilastollisesti merkitsevä vaikutus infektioiden esiintyvyyteen. Siten pilon-murtumaan liittyvän avomurtuman hoidossa infektioriskiä tulee pyrkiä pienentämään eri hoitomenetelmillä
Is Psychiatric Illness Associated With Worse Outcomes Following Pilon Fracture?
No full textBACKGROUND: Patients with psychiatric comorbidities represent a significant subset of those sustaining pilon fractures. The purpose of this study is to examine the association of psychiatric comorbidities (PC) in patients with pilon fractures and clinical outcomes. METHODS: A multi-institution, retrospective review was conducted. Inclusion/exclusion criteria were skeletally mature patients with a tibia pilon fracture (OTA Type 43B/C) who underwent definitive fracture fixation utilizing open reduction internal fixation (ORIF) with a minimum of 24 weeks of follow-up. Patients were stratified into two groups for comparison: PC group and no PC group. RESULTS: There were 103 patients with pilon fractures that met the inclusion/exclusion criteria of this study. Of these patients, 22 (21.4%) had at least one psychiatric comorbidity (PC) and 81 (78.6%) did not have psychiatric comorbidities (no PC). There was a higher percentage of female patients (PC: 59.1% vs no PC: 25.9%, p=0.0.005), smokers (PC: 40.9% vs no PC: 16.0%, p=0.02), and drug users (PC: 22.7% vs no PC: 8.6%, p=0.08) amongst PC patients. Fracture comminution (PC: 54.5% vs no PC: 32.1%, p=0.05) occurred more frequently in PC patients. The PC group had a higher incidence of weightbearing noncompliance (22.7% vs 7.5%, p=0.04) and reoperation (PC: 54.5% vs no PC: 29.6%, p=0.03). CONCLUSION: Patients with psychiatric comorbidities represent a significant percentage of pilon fracture patients and appear to be at higher risk for postoperative complication. Risk factors that may predispose patients in the PC group include smoking/substance use, weightbearing noncompliance, and fracture comminution. Level of Evidence: II
On the axial anomaly at finite temperature in the Schwinger model
No full textBaier R, Pilon E. On the axial anomaly at finite temperature in the Schwinger model. Zeitschrift für Physik C: Particles and fields. 1991;52(2):339-342.The axial anomaly in 2 dimensional QED at finite temperature is carefully investigated in the real time formalism in the limit of vanishing fermion mass. We follow the dispersion approach of Dolgov and Zakharov. The temperature independence of the anomaly is recovered
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