Pilon骨折的外科治疗(英文加翻译)

Objective:Todiscussthemethods,timingandclinicaloutcomesofsurgicaltreatmentforopenpilonfractures.Methods:FromApril2003toJuly2008,28patientswithopenpilonfracturesweretreated.AllhadtypeCfracturesaccordingtotheArbeitsgemeinschaftfürosteosynthesefragen–AssociationfortheStudyofInternalFixation(AO/ASIF)classification.Threeoperativemethodswereapplied,themethodsbeingdeterminedbythetypesoffracture,softtissuedamageandtimeintervalafterinjury.

第一页，编辑于星期五：八点二十四分。trauma创伤classification分类；分级debridement清创术、扩创术anatomicreduction解剖复位theArbeitsgemeinschaftfürosteosynthesefragen瑞士骨折内固定协会/AOBurwell-Charnleyscore骨折复位放射学评价标准1965Orthopaedic骨科的；整形外科的第二页，编辑于星期五：八点二十四分。Complication并发症sloughing蜕皮；脱落post-traumaticarthritis[ɑː'θraɪtɪs]创伤后关节炎Thorough彻底地'θʌrəanti-infectivemedication抗感染药物occurrence[ə'kʌr(ə)ns}发生tibial['tɪbɪəl]胫骨的talus['teɪləs]距骨softtissuedegloving(套袖状的)软组织撕裂第三页，编辑于星期五：八点二十四分。metaphyseal干骺端的第四页，编辑于星期五：八点二十四分。Sevencasesweretreatedbydebridementandinternalfixationwithplate;19bylimitedinternalfixationcombinedwithexternalfixation;and2bydelayedsurgery.TheclinicaloutcomeswereevaluatedbytheBurwell-Charnleyscore.Results:Allcaseswerefollowedupforfrom6to48months(average24months).TheBurwell-Charnleyscoreofclinicaloutcomes:anatomicreductionachievedin12cases,functionalreductionin15,andunsatisfactoryreductionin1.第五页，编辑于星期五：八点二十四分。Thehealingtimewasfrom2.5to11months(average4.7months).Twocaseshaddelayedunion.Accordingtothe

AmericanOrthopaedicFootandAnkleSociety(AOFAS)scalefortheanklejoint,therewereexcellentresultsin8cases,goodin14,fairin5andpoorin1.Complicationsincludedfourcasesofskinsuperficialsloughing,twoofsuperficialinfection,oneofdeepinfection,twoofdelayedfractureunionandtenofpost-traumaticarthritis.

第六页，编辑于星期五：八点二十四分。Thoroughdebridement,properuseofanti-infectivemedication,appropriatebonegrafting,andpostoperativeanklefunctionexercisecanreducetheoccurrenceofcomplications.

第七页，编辑于星期五：八点二十四分。trauma创伤classification分类；分级debridement清创术、扩创术anatomicreduction解剖复位Complication并发症sloughing蜕皮；脱落post-traumaticarthritis[ɑː'θraɪtɪs]创伤后关节炎Thorough彻底地'θʌrə第八页，编辑于星期五：八点二十四分。anti-infectivemedication抗感染药物occurrence[ə'kʌr(ə)ns}发生tibial['tɪbɪəl]胫骨的；tibia['tɪbɪə]胫骨talus['teɪləs]距骨softtissuedegloving软组织撕裂lowerlimbfractures下肢骨折degloving套袖状撕裂metaphyseal干骺端的articulardepression关节压缩weightbearingarea负重区第九页，编辑于星期五：八点二十四分。implant内植物approach方法correspondencen.通信；一致；相当DOI：数字对象唯一标识符bilaterally[bai'lætərəli]双边地malleolus[mæ'liːələs]踝clinic临床；诊所motor发动机vehicle[ˈviːəkl]（车辆）accident第十页，编辑于星期五：八点二十四分。Openfracturescomprisesabout10%to30%ofallpilonfractures3.Thesefracturesareoftenassociatedwithsignificantsofttissuedegloving,metaphysealbonedefectsandarticulardepression.第十一页，编辑于星期五：八点二十四分。Introduction

Pilonfractureconstitutes1%ofalllowerlimbfractures

andabout3%to10%oftibialfractures1,2.Itisusuallytheresultofhighenergyinjurytotheweightbearingareaofthelowerendofthetibiabythetalus.第十二页，编辑于星期五：八点二十四分。Conclusion:

Itisimportanttoperformappropriatesurgeriesforopenpilonfractureaccordingtofractureclassification,differentdamagetoskinandtissueandtimeintervalafterinjury.第十三页，编辑于星期五：八点二十四分。Keywords:Delayedoperation;Externalfixators;Fracturesopen;Internalfixators

第十四页，编辑于星期五：八点二十四分。Inspiteofimprovementsinsurgicalapproachesandimplants,treatmentoftibialpilonfracturesremainschallenging4.

第十五页，编辑于星期五：八点二十四分。Inthepresentstudy,wediscussthemethods,timingandclinicaloutcomesofsurgicaltreatmentforopenpilonfractures.第十六页，编辑于星期五：八点二十四分。AddressforcorrespondenceXian-tieZeng,MD,DepartmentofTrauma,TianjinHospital,Tianjin,China300211Tel:0086-

;Fax:0086;Email:

Received:19July2010;accepted5October2010

DOI:10.1111/j.1757-7861.2010.00113.x

第十七页，编辑于星期五：八点二十四分。MaterialsandMethods

Patientdata

FromApril2003toJuly2008,28patientswithopentibialpilonfracturesweretreatedinourhospital.

第十八页，编辑于星期五：八点二十四分。Therewere21menand7womenwithanaverageageof36.5years(range,19–61years).Tenpatientswereinjuredontheleftside,17ontherightand1bilaterally(aclosedfractureoftherightmalleolus（踝）wasnotcounted).第十九页，编辑于星期五：八点二十四分。Theintervalbetweeninjuryandpresentationtoourclinicrangedfrom1to14hours(average,5.1hours).Themechanismsofinjurywerehigh-energyfallsin10cases,motorvehicleaccidentsin12,crushinginjury（挤压伤）in4cases,andsportsinjuriesin2.

第二十页，编辑于星期五：八点二十四分。ThefractureswereclassifiedaccordingtotheAO/ASIFsystem:7wereclassifiedastypeC1,17typeC2,and4typeC3.

第二十一页，编辑于星期五：八点二十四分。OpensofttissuedamagewasgradedaccordingtotheGustilosystem:4caseswereclassifiedasGustiloI,21GustiloII,2GustiloIIIA,and1GustiloIIIB.

第二十二页，编辑于星期五：八点二十四分。acetabularæsə'tæbjulə]髋臼的fibular腓骨的;fibula腓骨femoral股骨的Calcaneal[kæl'keiniəl跟骨的craniocerebral[,kreiniəusi'ri:brəl颅脑的protocol方法、协议presentingwith伴随restoration恢复tibia胫骨第二十三页，编辑于星期五：八点二十四分。cancellous

['kæns(ə)ləs]松质骨insertion插入modified改进的cloverleaf三叶草形Anteromedial前内侧的medial内侧的posterolateral后外侧的lateral外侧的constraint约束、限制

keepinginmind牢记anteroposterior前后的；正位（影像）第二十四页，编辑于星期五：八点二十四分。Combinedinjuriesincludedfibularfracturesin25cases,spinalfracturesin2,upper-armfracturesin2,ribfracturesin2,femoralfracturein1,acetabularfracturein1,calcanealfracturein1,andcraniocerebraltraumain1.

第二十五页，编辑于星期五：八点二十四分。demonstrating显示

Calcaneus（口Ki尼尔斯）：跟骨metatarsal跖骨的anklemortise踝关节Kirschner克氏pin克氏针第二十六页，编辑于星期五：八点二十四分。Methods

Oneofthreedifferentsurgicalprotocolswasperformedinallpatients,thechoicebeingbasedontheconditionofsofttissue,typeoffractureandlengthofintervalbetween

injuryandpresentationfortreatment.

第二十七页，编辑于星期五：八点二十四分。Debridement,open

reductionand

internalfixation(ORIF)

ThismethodwasappliedintypeC1fracturespresentingwithlow-gradesofttissueinjury(GustiloI,II)andintervalbetweeninjuryandpresentationfortreatmentoflessthan6hours.

第二十八页，编辑于星期五：八点二十四分。Sevenpatients(fourtypeC1GustiloIandthreetypeC1GustiloII)weretreatedbythismethod.

第二十九页，编辑于星期五：八点二十四分。Surgicaltreatmentofthepilonfractureswasinfoursteps:(a)restorationofthecorrectlengthand

stabilizationofthefibula;第三十页，编辑于星期五：八点二十四分。(b)reconstructionofthearticularsurfaceofthetibia;(c)insertionofcancellousautografts;and(d)stabilizationofthemedialaspectofthetibiawiththeuseofamodifiedcloverleafplate.

第三十一页，编辑于星期五：八点二十四分。Ananteromedialincisionwasemployedtotreatthetibialcomponentandalateralorposterolateralincisiontotreatthefibularfracture.

第三十二页，编辑于星期五：八点二十四分。Thesurgicalincisionswereplannedbasedontherequirementsofthefracturepattern,keepinginmindthesoft-tissueconstraintsoftheindividualinjury.第三十三页，编辑于星期五：八点二十四分。Skinclosurewasachievedwithnotension.Thetibialincisionswereclosedfirst.Ifnecessary,thefibularincisionswereleftfordelayedclosure.

第三十四页，编辑于星期五：八点二十四分。Oneofthesevenpatientsachievedprimaryclosureofthemedialincision,followedbydelayedclosureofthelateralone.AtypicalcaseisshowninFig.1.第三十五页，编辑于星期五：八点二十四分。Figure1

A49year-oldmanwithalow-energyopenpilonfracture(GustiloI&C1)(a)Photographshowingopensofttissueinjury(GustiloI).(b)PreoperativeanteroposteriorandlateralradiographsshowingPilonfractureoftypeC1.(c)Postoperativeradiographsshowingthefractureshavebeenanatomicallyreducedandfixedwithplates.(d)Anteroposteriorandlateralradiographsdemonstratingfractureshavehealed1yearaftersurgery.

第三十六页，编辑于星期五：八点二十四分。第三十七页，编辑于星期五：八点二十四分。Figure2A22year-oldmanwithahigh-energyopenpilonfracture(GustiloII&C2)(a)Photographshowingopensofttissueinjury(GustiloII).(b)PreoperativeradiographsshowingPilonfractureoftypeC2.

第三十八页，编辑于星期五：八点二十四分。(c)Postoperativeradiographsshowingthefractureshavebeenanatomicallyreducedandfixedwithexternalfixation,andthetibialfracturefixedwithlimitedinternalfixation.(d)Anteroposteriorandlateralradiographs

demonstratingthefractureshavehealed1.5yearaftersurgery.

第三十九页，编辑于星期五：八点二十四分。Debridement,limited

ORIF

and

externalfixation

ThismethodwasappliedintypeC2andtypeC3fracturespresentingwithhigh-gradesofttissueinjury(GustiloII,III)andintervalbetweeninjuryandpresentationfortreatmentoflessthan8hours.

第四十页，编辑于星期五：八点二十四分。Nineteenpatients(16typeC2GustiloII,1typeC2GustiloIIIA,and2typeC3GustiloII)weretreatedbythismethod.

第四十一页，编辑于星期五：八点二十四分。Thepatientsweremanagedbyimmediate（直接的）debridementofthewound.Fibularfractureswerealwaysinternallyfixed,eitherwitha1/3tubular（管状的）plateor3.5mmcompressionplate.

第四十二页，编辑于星期五：八点二十四分。Externalfixationwasappliedacrosstheankle

jointwithpinsinthecalcaneus,metatarsalbone,andtibia,reconstructionoftheanklemortise（踝关节）,andstabilizationwithscrewsorKirschnerpins.

第四十三页，编辑于星期五：八点二十四分。split-thicknessskingrafting厚皮瓣转移splint夹板edema（水肿）antibiotic（抗生素）extent（范围）contamination（污染）Theaffectedextremity（下肢）elevate抬高；提高subtalar（距下）第四十四页，编辑于星期五：八点二十四分。proscribe（禁止）supervise（指导）physicaltherapy

program（康复锻炼）Roll-A-Boutwalker（助行器）outpatients(门诊就诊)Staphylococcus

epidermidis（表皮葡萄球菌）Acinetobacterbaumannii（鲍氏不动杆菌）第四十五页，编辑于星期五：八点二十四分。Fiveofthe19patientsrequiredbonegraftingbecauseoflargedefectsofmetaphysealbone.Onecaseunderwentdelayedclosureofthelateralincision,anddelayedsplit-thicknessskingraftingwasappliedinanothercase.AtypicalcaseisshowninFig.2.

第四十六页，编辑于星期五：八点二十四分。posttraumaticarthritis.（创伤后关节炎）

ankle-hind（后踝）第四十七页，编辑于星期五：八点二十四分。Debridement

and

calcaneal

traction,delayedsurgeryThismethodwasappliedintypeC3fracturesaccompaniedbyhigh-gradesofttissueinjury(GustiloIII)and

intervalbetweeninjuryandpresentationfortreatmentof

morethan8hours.第四十八页，编辑于星期五：八点二十四分。Intwopatients(onetypeC3Gustilo

IIIA,onetypeC3GustiloIIIB),thesurgeonchoseatwo

stageprocedure（步骤）.第四十九页，编辑于星期五：八点二十四分。Thepatientswereputoncalcanealpin

skeletaltractionwithelevationofthelowerlimbovera

Bohler–Braunsplint（勃朗支架）,andmeasuresweretakentoavoid

edema（水肿）.第五十页，编辑于星期五：八点二十四分。Wounddrainage（引流管）wasremovedwhentherewasno

furtherevidenceofinfection,andasecondstageoperationwasperformedwhentheedemahadalmostcompletelyresolved.第五十一页，编辑于星期五：八点二十四分。ThepatientsweretreatedwithlimitedORIFandexternalfixation.Thetimeintervalbetweenthetwosurgerieswas15and19days,respectively.Atypical

caseisshowninFig.3第五十二页，编辑于星期五：八点二十四分。第五十三页，编辑于星期五：八点二十四分。Figure3A37year-oldmanwithasuperhigh-energyopenpilonfracture(GustiloIIIB&C3)(a)Photographshowingopensofttissueinjury(GustiloIIIB)(b)PreoperativeradiographsshowingPilonfractureoftypeC3.第五十四页，编辑于星期五：八点二十四分。(c)Postoperativeradiographsshowingthefractureshave

beenanatomicallyreducedandfixedwithexternalfixation,thetibialfixedwithlimitedinternalfixation,andthefibulawithaplate.(d)Anteroposteriorandlateralradiographsdemonstratingthefractureshavehealed1.5yearaftersurgery.第五十五页，编辑于星期五：八点二十四分。PostoperativecareAppropriatecultures（培养）wereobtainedduringsurgery,and

broad-spectrumantibiotics（广谱抗生素）wereadministered.（执行，使用）

The

choiceofantibiotic（抗生素）wasbasedontheextent（范围）anddegreeof

contamination（污染）.

第五十六页，编辑于星期五：八点二十四分。Activeankleandsubtalar（距下）jointrange-of-motionexerciseswerebegunassoonasthe

woundwasdry,usuallybetween2and5daysaftersurgery.Weight-bearingexercisewasproscribed（禁止）inthefirst12

weeksaftersurgery.第五十七页，编辑于星期五：八点二十四分。Asupervised（指导）physicaltherapy

program（康复锻炼）encouragingactiveanklerange-of-motionexerciseswasemployedforthefirst6weeks.Thiswasprogressedtoincludepassiveexercisesbetween6and12

weeks.ARoll-A-Boutwalker（助行器）wasusedwhennecessary.第五十八页，编辑于星期五：八点二十四分。Theaffectedextremity（下肢）waselevated（提高）continuouslyforthefirst48hoursandthen,asmuchas

possible,forthenext7days.第五十九页，编辑于星期五：八点二十四分。procedure（步骤）broad-spectrumantibiotics（广谱抗生素）extremity手足outpatients(门诊就诊)medial（内侧）originally(最初）dissection（解剖，切开）stripping（剥离）第六十页，编辑于星期五：八点二十四分。posttraumaticarthritis.（创伤后关节炎）ankle-hind（后踝）originally(最初)dissection（解剖，切开）stripping（剥离）ligamentotaxis（韧带修复术）neutralization（中和）in

regardto（关于）第六十一页，编辑于星期五：八点二十四分。Radiographs

wereobtainedandevaluatedaccordingtotheBurwell

Charnleysystem:anatomicreductionwasachieved

in12cases,functionalreductionin15cases,andpoorreductionin1case.第六十二页，编辑于星期五：八点二十四分。Thehealingtimeofthefracturewasfrom2.5to11months,withanaverageof4.7months.第六十三页，编辑于星期五：八点二十四分。Results

All28patientswerefollowedupfrom6to48months

withanaverageof24months,andunderwentclinicaland

radiologicalexaminationasoutpatients(门诊就诊).第六十四页，编辑于星期五：八点二十四分。Delayedunionwasfoundintwocases;inbothitwas

associatedwithbonedefectsofthemedial（内侧）tibia.Onestage

woundclosurewasperformedin18patients,twounderwentdelayedclosureoftheirlateralincisions,andone

underwentdelayedsplit-thicknessskingrafting.第六十五页，编辑于星期五：八点二十四分。There

werefourcasesofsuperficialsloughingoftheskin.Two

patientsdevelopedsurfaceinfectionwithStaphylococcus

epidermidis（表皮葡萄球菌）andAcinetobacterbaumannii（鲍氏不动杆菌）andonedevelopeddeepinfectionwithAcinetobacterbaumannii;the

infectionratewas10.7%(3/28).第六十六页，编辑于星期五：八点二十四分。Tenpatients(35.7%)

showedevidenceofposttraumaticarthritis.（创伤后关节炎）

Accordingto

theAOFASankle-hind（后踝）footfunctionevaluation（评估）,the

averagescorewas85.2(range,66to98):excellentin8

patients,goodin14,fairin5,andpoorin1.第六十七页，编辑于星期五：八点二十四分。DiscussionChoiceofsurgicalmethodsInpatientswithtypeC1fractureandGustiloIsoft

tissueinjuryduetolow-energyforces,pilonfracturewas

anatomicallyreducedandtreatedwithdebridementandinternalplatefixationfollowingAO/ASIFprinciples.第六十八页，编辑于星期五：八点二十四分。Openreductionandinternalfixationwereoriginally(最初)used,butitisnowknownthatopenreductionincreasestherisk

ofcomplicationsafterhigh-energytrauma.第六十九页，编辑于星期五：八点二十四分。Thisisprobablyrelatedtotheamountofdissection（解剖，切开）andstripping（剥离）of

softtissueswhichisneededtoachievereductionandplate

fixation.第七十页，编辑于星期五：八点二十四分。Therefore,whenperformingORIFprocedures,thesurgeonstriedtolimitsofttissuedamageandchoose

suitableinternalfixation.第七十一页，编辑于星期五：八点二十四分。Thetibiawasreducedwitha

cloverleafplate,dynamiccompressionplateorlocking

compressionplate,dependingonthelevelofthefracture

anddegreeofstabilityrequired.第七十二页，编辑于星期五：八点二十四分。Linetal.reportedan

83.3%goodratein30casestreatedwithORIFfollowed

upfor17~39months5.Kalendereretal.alsoreporteda

similarresult6.第七十三页，编辑于星期五：八点二十四分。ExternalfixationandlimitedinternalfixationwereperformedinallpatientswithtypeC2andtypeC3fractures

presentingwithhigh-gradesofttissueinjury(GustiloII

andIII)andintervalbetweeninjuryandpresentationat

theauthors’clinicoflessthan8hours.

第七十四页，编辑于星期五：八点二十四分。Useofexternal

fixationduringthesurgicalprocedureenables（使能够）thesurgeon

toassess（评估）thelengthandhelpsstabilizethelimb（肢）forreconstructionoftheintra-articular（关节内）component.第七十五页，编辑于星期五：八点二十四分。Placement（放置）of

theexternalfixatorwithacalcanealpinandahalf-pinin

thetibiaallowsligamentotaxis（韧带修复术）tooccurthroughtraction

onthecalcanealpin.第七十六页，编辑于星期五：八点二十四分。第七十七页，编辑于星期五：八点二十四分。initial(首先)distraction（牵引）eliminate（清除）compromise（妥协、折衷、让步）exposure（显露，暴露）incidence（发生率）malalignment(对线不良)stiffness（僵硬）['stɪfnɪs]第七十八页，编辑于星期五：八点二十四分。preclude（排除）Pre-existing（已存在）inviewof（鉴于，考虑到）ischemia（缺血）[ɪs'kimɪə]precarious（不确定的）[prɪ'keərɪəs]第七十九页，编辑于星期五：八点二十四分。Thisishelpfulinreductionofthe

fractureandallowseasieraccessto（入路）theanklejointfor

joint

reconstruction.第八十页，编辑于星期五：八点二十四分。Usedasaneutralization（中和）device,thereisno

needforlargeplateswiththeassociated（相关）increasedriskof

skinsloughing7.第八十一页，编辑于星期五：八点二十四分。Minimizing（将...减到最少）internalfixationanddamage

tosofttissuesandbloodsupplydecreasestherateofskin

sloughingandinfection.第八十二页，编辑于星期五：八点二十四分。Wewereabletocorrectpostoperativelossofreduction（再移位）byadjustingexternalfixation.It

isalsoanexcellentdeviceinthoseseverelycomminuted

fracturesthatdonotallowstablefixationwiththeuseofa

plate.第八十三页，编辑于星期五：八点二十四分。Severalresearchershavereportedsimilarfindingsin

regardto（关于）externalfixation8–11.第八十四页，编辑于星期五：八点二十四分。Ourresultsleadustorecommend(建议，推荐)thatTypeC3tibial

pilonfracturespresentingwithhigh-gradesofttissue

injury(GustiloIII)andintervalbetweeninjuryandpresentation

fortreatmentofmorethan8hoursshouldbe

treatedwithatwo-stageprocedure.第八十五页，编辑于星期五：八点二十四分。Atinitial(首先)presentation,anexternalfixatorisapplied.Afterthesofttissueshave

recovered,thesecondstageisperformed.第八十六页，编辑于星期五：八点二十四分。Thegoalofthe

firststageistore-establishthelength,alignmentandrotation

oftheextremityandprovideanenvironmentfor

soft-tissuerecovery.第八十七页，编辑于星期五：八点二十四分。Theearlyapplicationofadistraction（牵引）forcemayhelptolimitanysecondaryinjuryandeliminate（清除）additionalsofttissuecompromise（妥协、折衷、让步）duringsurgicalexposure（显露，暴露）12.第八十八页，编辑于星期五：八点二十四分。Severalreportshaveshownthatthetwo-stageprocedure

canreducetherateofcomplicationssuchas

infection,skinsloughing,andpost-traumaticarthritis13–15.第八十九页，编辑于星期五：八点二十四分。Preventionofpostoperativecomplications.Ithasbeenreportedthattheincidence（发生率）ofcomplications,includingwoundproblems,skinsloughing,infection,nonunion,malalignment(对线不良),jointstiffness（僵硬）andposttraumaticarthritis,ishigh(45.1%)inpatientswithsevere

pilonfractures16.第九十页，编辑于星期五：八点二十四分。Skinsloughingandinfectionarethemostimportant

earlypostoperativecomplications17.Pre-existing（已存在）severe

softtissueinjuryprecludes（不能）openreductioninviewof（考虑到）the

potentialwoundproblemsduetoischemia（缺血）orinfectionof

thesofttissues.第九十一页，编辑于星期五：八点二十四分。Theprecarious（不确定的）bloodsupplyinthisregion

ofthetibiacancontributeto（有助于）theproblemsofbothnonunion

andinfection18.第九十二页，编辑于星期五：八点二十四分。Intensive（加强的）outweigh（胜过，强过）

lateralcolumn(外侧柱)ligament（韧带）taxis（整复）circularframes（圆形框架）hybridsystems（混合系统）['haɪbrɪd]第九十三页，编辑于星期五：八点二十四分。hingeaxis（铰链轴）[hɪndʒ]plastercast（石膏）optimal（最佳的）manuscript（手稿，文章）

第九十四页，编辑于星期五：八点二十四分。Inthepresentstudy,therewerefour

casesofskinsloughing,twoofsuperficialinfections,and

onlyoneofdeepboneinfection.第九十五页，编辑于星期五：八点二十四分。Surgicalapproachesare

nowplannedbasedonthe

requirementsofthefracture

pattern,keepinginmindthesoft-tissueconstraintsofthe

individualinjury.第九十六页，编辑于星期五：八点二十四分。Theincisionsarekeptatleast7cmapart

topreventsoft-tissueischemiaandsecondarywoundbreakdown.第九十七页，编辑于星期五：八点二十四分。Intensive（加强的）debridement,minimizationofsofttissuestrippingandproperuseofantibioticsareusefulfor

preventinginfection.第九十八页，编辑于星期五：八点二十四分。Delayedunion,especiallyinthemetaphysealportion,is

alsoaproblemwithpilonfractures.Wenoteda7.1%

delayedunionrateinthisseries.第九十九页，编辑于星期五：八点二十四分。Theseverityoftheinjury

andpoorbloodsupplytothedistaltibiamayoutweigh（胜过，强过）the

affectsofanyparticularapproachwhenitcomestononunionordelayedunion,anditisalsoprobablycausedby

tibialbonedefectafterfixationofthefibula.Butthereis

notdecidedforthefibulafixation19,20.第一百页，编辑于星期五：八点二十四分。Wethinkthat

fibularfractureshouldbefixed