Fracture Line Morphology and a Novel Classification of Pilon Fractures
ABSTRACT Objective Currently, there is no research that includes a comprehensive three‐dimensional fracture mapping encompassing all types of Pilon fractures. Moreover, the existing classification systems for Pilon fractures exhibit only moderate to fair consistency and reproducibility. Additionally...
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Wiley
2025-02-01
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| Series: | Orthopaedic Surgery |
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| Online Access: | https://doi.org/10.1111/os.14304 |
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| author | Jichao Liu Chengdong Piao Guanlu Cui Haipeng Sun Zhengwei Li |
| author_facet | Jichao Liu Chengdong Piao Guanlu Cui Haipeng Sun Zhengwei Li |
| author_sort | Jichao Liu |
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| description | ABSTRACT Objective Currently, there is no research that includes a comprehensive three‐dimensional fracture mapping encompassing all types of Pilon fractures. Moreover, the existing classification systems for Pilon fractures exhibit only moderate to fair consistency and reproducibility. Additionally, some of these classification systems fail to accurately depict the morphological characteristics of the fractures. This study aimed to create a fracture map encompassing all types of Pilon fractures by three‐dimensional fracture mapping. In addition, this study conducted a finite element analysis of the normal ankle joint, and based on the distribution of fracture lines and the stress distribution at the distal tibia, proposed a new classification for Pilon fractures. Methods A retrospective analysis of Pilon fractures in our hospital from January 2018 to January 2024 was performed. A total of two hundred forty‐four Pilon fractures were included, and their fracture lines were transcribed onto the tibia and fibula templates, and fracture maps and heat maps were created. A nonhomogeneous model of the ankle joint was constructed and verified, and the stress distribution on the distal tibia articular surface was measured and analyzed in three models (neutral, dorsiflexed, and plantarflexed model). Based on the fracture map and stress distribution, a five‐column classification system for Pilon fractures was proposed, and the intraobserver and interobserver reliability was calculated using Cohen and Fleiss k statistics. Result The fracture line on the distal tibia articular surface showed a V‐shaped distribution. One branch extended from the junction of the medial malleolar articular surface and the inferior tibial articular surface toward the medial malleolus. The other branch extended from the middle of the fibular notch to the posterior part of the medial ankle, toward the tibial shaft. The fibula fracture line mainly extended from the anterior and lower part of the lateral malleolus to the posterior and upper part. As evidenced by the neutral, dorsiflexed, and plantar flexion models, the stress on the posterolateral articular surface (posterolateral column) was low, while the majority of the stress was concentrated in the center. Three‐column fractures were the most common, followed by two‐column fractures. Using the five‐column classification, the K‐weighted values of interobserver and intraobserver analysis were 0.653 (p < 0.001) and 0.708 (p < 0.001), respectively. Conclusions In this study, the fracture line and morphological characteristics of Pilon fractures were analyzed in detail by three‐dimensional mapping. In addition, this study conducted a finite element analysis of the stress distribution on the distal tibial joint surface of the normal ankle joint. Moreover, a novel classification system was proposed to reflect these findings. The new classification not only exhibits greater consistency, facilitating accurate communication of fracture characteristics among surgeons, but also aids in understanding the mechanisms of injury and formulating surgical strategies. |
| format | Article |
| id | doaj-art-a20f746079074e0fbef3b936dd08f81f |
| institution | Kabale University |
| issn | 1757-7853 1757-7861 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Wiley |
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| series | Orthopaedic Surgery |
| spelling | doaj-art-a20f746079074e0fbef3b936dd08f81f2025-02-03T03:10:59ZengWileyOrthopaedic Surgery1757-78531757-78612025-02-0117254055010.1111/os.14304Fracture Line Morphology and a Novel Classification of Pilon FracturesJichao Liu0Chengdong Piao1Guanlu Cui2Haipeng Sun3Zhengwei Li4Department of Orthopedics The Second Hospital of Jilin University Changchun Jilin ChinaDepartment of Orthopedics The Second Hospital of Jilin University Changchun Jilin ChinaDepartment of Orthopedics The Second Hospital of Jilin University Changchun Jilin ChinaDepartment of Orthopedics The Second Hospital of Jilin University Changchun Jilin ChinaDepartment of Orthopedics The Second Hospital of Jilin University Changchun Jilin ChinaABSTRACT Objective Currently, there is no research that includes a comprehensive three‐dimensional fracture mapping encompassing all types of Pilon fractures. Moreover, the existing classification systems for Pilon fractures exhibit only moderate to fair consistency and reproducibility. Additionally, some of these classification systems fail to accurately depict the morphological characteristics of the fractures. This study aimed to create a fracture map encompassing all types of Pilon fractures by three‐dimensional fracture mapping. In addition, this study conducted a finite element analysis of the normal ankle joint, and based on the distribution of fracture lines and the stress distribution at the distal tibia, proposed a new classification for Pilon fractures. Methods A retrospective analysis of Pilon fractures in our hospital from January 2018 to January 2024 was performed. A total of two hundred forty‐four Pilon fractures were included, and their fracture lines were transcribed onto the tibia and fibula templates, and fracture maps and heat maps were created. A nonhomogeneous model of the ankle joint was constructed and verified, and the stress distribution on the distal tibia articular surface was measured and analyzed in three models (neutral, dorsiflexed, and plantarflexed model). Based on the fracture map and stress distribution, a five‐column classification system for Pilon fractures was proposed, and the intraobserver and interobserver reliability was calculated using Cohen and Fleiss k statistics. Result The fracture line on the distal tibia articular surface showed a V‐shaped distribution. One branch extended from the junction of the medial malleolar articular surface and the inferior tibial articular surface toward the medial malleolus. The other branch extended from the middle of the fibular notch to the posterior part of the medial ankle, toward the tibial shaft. The fibula fracture line mainly extended from the anterior and lower part of the lateral malleolus to the posterior and upper part. As evidenced by the neutral, dorsiflexed, and plantar flexion models, the stress on the posterolateral articular surface (posterolateral column) was low, while the majority of the stress was concentrated in the center. Three‐column fractures were the most common, followed by two‐column fractures. Using the five‐column classification, the K‐weighted values of interobserver and intraobserver analysis were 0.653 (p < 0.001) and 0.708 (p < 0.001), respectively. Conclusions In this study, the fracture line and morphological characteristics of Pilon fractures were analyzed in detail by three‐dimensional mapping. In addition, this study conducted a finite element analysis of the stress distribution on the distal tibial joint surface of the normal ankle joint. Moreover, a novel classification system was proposed to reflect these findings. The new classification not only exhibits greater consistency, facilitating accurate communication of fracture characteristics among surgeons, but also aids in understanding the mechanisms of injury and formulating surgical strategies.https://doi.org/10.1111/os.14304classificationcomputed tomographyfinite element analysisfracture mappingpilon fractures |
| spellingShingle | Jichao Liu Chengdong Piao Guanlu Cui Haipeng Sun Zhengwei Li Fracture Line Morphology and a Novel Classification of Pilon Fractures Orthopaedic Surgery classification computed tomography finite element analysis fracture mapping pilon fractures |
| title | Fracture Line Morphology and a Novel Classification of Pilon Fractures |
| title_full | Fracture Line Morphology and a Novel Classification of Pilon Fractures |
| title_fullStr | Fracture Line Morphology and a Novel Classification of Pilon Fractures |
| title_full_unstemmed | Fracture Line Morphology and a Novel Classification of Pilon Fractures |
| title_short | Fracture Line Morphology and a Novel Classification of Pilon Fractures |
| title_sort | fracture line morphology and a novel classification of pilon fractures |
| topic | classification computed tomography finite element analysis fracture mapping pilon fractures |
| url | https://doi.org/10.1111/os.14304 |
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