Abstract
The paper propose a complex annalysis regarding etiopathogenic approach of the tibial pilon. The study was made upon the articular fractures of distal tibia, hospitalised and treated in Orthopaedic-Traumatology Clinic of Constanta Emergency Clinical Hospital, between 2007-2011, and consist of 245 patients. The lesional graduality will be found in the anathomoclinical forms of the fractures. The grade of soft tissue devitalisation will influence the local evolution and will promote the appearance and extension of skin necrosis in case of ireversible ischemia. In case of direct trauma, but with low energy or in case of indirect trauma, perifracture lesions are restrained and evolution can be favourable to cicatrization. The correct dyagnosis of these fractures are a mandatory stage of the presurgical planning and was made by annalysing the x-rays made in 2 incidencies, in emergency, and which were repeated when it was needed.
The lesional graduality of bone and soft tissue structures is direct proportional with the type of traumatic mechanism and with the level of energy which produced the fracture. The traumatic mechanism can produce lesional characteristics, by direct mechanism (work accidents, falling from high or same level) or by indirect mechanism with forces transmitted through talus (forced inversion/eversion).
The fracture type must be evaluated upon the clinical and prognostical criteria of AO and Ruedi-Allgower classification, which suggest the therapeutical manners too. The evaluation of soft tissues is made by the Gustilo-Anderson classification, the only one which can establish correctly the graduality and the severity of lesions.