ABSTRACT
Objective:To investigate the clinical efficacy of posteromedial approach through anterior border of tibialis posterior tendon combined with posterolateral approach in open reduction and internal fixation of Klammer type II/III posterior pilon variant fracture.Methods:A retrospective case series study was conducted on 37 patients with posterior pilon variant fracture treated by posteromedial approach through anterior border of tibialis posterior tendon combined with posterolateral approach in Jiangsu Province People's Hospital and its Liyang branch between January 2015 and December 2019. There were 17 males and 20 females, aged 25-65 years［（49.5±9.3）years］. Klammer classification was type II in 20 patients and type III in 17 patients. The quality of fracture reduction, incision healing and postoperative complications were observed. The loss of fracture reduction or implant failure was detected during the follow-up. The fracture union time was recorded. At the final follow-up, the residual pain was assessed by the visual analogue scale（VAS）and the ankle function by the American Orthopedic Foot and Ankle Society（AOFAS）ankle-hindfoot score.Results:All patients were followed up for 12-20 months［（15.6±1.2）months］. An anatomic fracture reduction was observed in all patients, showing the incision healing by first intention. No skin necrosis, posteromedial neurovascular bundle injury, deep venous thrombosis, checkrein deformity or other complications occurred. During the follow-up, there was no reduction loss or implant failure. The fracture healing time ranged from 11 to 16 weeks［（13.2±1.4）weeks］. At the final follow-up, the VAS was decreased from 6-9 points［（8.0±0.8）points］preoperatively to 0-2 points［（1.2±0.6）points］（ P<0.01）. At the final follow-up, the AOFAS ankle-hindfoot score ranged from 80 to 100 points［（89.7±4.6）points］, which showed excellent results in 15 patients and good in 22 patients, with the excellence rate of 100%. Conclusion:The posteromedial approach through anterior border of tibialis posterior tendon combined with posterolateral approach in open reduction and internal fixation of Klammer type II/III posterior pilon variant fracture can achieve good fracture reduction, with low incidence of complications, pain relief and satisfactory ankle function recovery.