ABSTRACT
PURPOSE@#To analyze the curative effect and technical points of a modified posteromedial approach in the treatment of Klammer III posterior Pilon fracture.@*METHODS@#A retrospective analysis of patients with Klammer III posterior Pilon fractures were conducted in our department from January 2018 to December 2019. Before the surgery, the patients were fully relieved of swelling and pain, and a comprehensive examination was carried out. The posteromedial approach exposed the posterior and medial fracture block of the distal tibia. According to the fracture of external malleolus, it is determined whether to combine a lateral incision and protect tendons and vascular nerves by a retractor, and then perform a fracture reduction and internal fixation. Postoperatively, the patients were treated with analgesia, detumescence, anticoagulation and rehabilitation exercise. The American orthopaedic foot and ankle society (AOFAS) score and visual analogue score were recorded at regular follow-up after surgery. A t-test was used for the comparison of the preoperative and final AOFAS score.@*RESULTS@#There were 7 male and 13 female (n = 20) included in the study, aged 22 to 88 years (average age 54.2 years). The injury mechanisms were falling from a height (n = 7), traffic accident (n = 6), walking injury (n = 2) and heavy injury (n = 5). The postoperative follow-up duration was 12-24 months (mean 16.95 months). The AOFAS score of the 20 patients before and after surgery were compared. The preoperative AOFAS score was 38.90 ± 3.91, and the final AOFAS score was 80.55 ± 4.20, (p < 0.001). The mean final visual analogue scores at rest, active and weight-bearing walking were 0.30, 0.85 and 1.70, respectively. One patient reported poor postoperative wound healing and required a return to hospital for debridement and anti-infection treatment.@*CONCLUSION@#In the treatment of Klammer III posterior Pilon fractures, the modified posteromedial approach can fully expose the fracture block and the collapsed articular surface of the medial malleolus, achieve good reduction and internal fixation with limited injury of the tendon and vascular nerves, and have a better prognosis.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Ankle Fractures/surgery , Fracture Fixation, Internal , Retrospective Studies , Tibial Fractures/surgery , Treatment OutcomeABSTRACT
Objective To summarize the epidemiological characteristics of ankle fractures and clinical outcome of open reduction and fixation for the treatment of posterior Pilon fracture with supporting plate. Methods From January 1st,2013 to December 31st,2016,the data of three hundred and twelve patients with ankle fracture in Jinshan Hospital of Fudan University were collected, and 21 cases of posterior Pilon fracture were treated with open reduction and fixation using supporting plate and were followed up,the ankle function was assessed by American Orthopaedic Foot and Ankle Society ankle hindfoot scale. Results There were 312 patients with ankle fractures,180 males,132 females. The age distribution of patients was as follows:1. 28%,12. 82%,14. 42%,24. 04%,28. 53%,11. 54%,6. 09% and 1. 28% in the following age group:≥18 and≤20 years of age,>20 and ≤30 years of age,>30 and ≤40 years of age,40> and ≤50 years of age,>50 and≤60 years of age,>60 and ≤70 years of age,>70 and ≤80 years of age and >80years of age. Traffic accidents (49%),sprains(31%),falling injury (11%),heavy pound(6%) were the main causes of ankle fractures. In terms of fracture types,238 (76. 2%) cases with lateral malleolus,235 (75. 3%) cases with medial malleolus fractures,161 (51. 6%) cases with posterior malleolus,and 105 (33. 7%) cases with trimalleolar fracture,21 (6. 8%)cases with posterior Pilon fracture. 21 patients with posterior Pilon fracture were followed up for 13. 0 to 56. 0 months,with an average of (31. 7±12. 6) months. Postoperative incision infection occurred in 3 patients,of which 1 cases had mild external leakage,and all wounds healed after dressing change. No fracture and screw prolapse occurred in all follow-up patients. The average score of AOFAS was (87. 2± 7. 1) points,of which 9 cases were excellent,10 cases were good,and 2 cases were fair. Conclusion Patients with ankle fractures were more common in males aged 60 and below,while in patients above 60 years old,the majority patients were females. In addition,patients aged 40 to 60 years old accounts for more than half of the population and the most common age group were between 50 and 60 years old. Traffic accidents and sprains are the common causes. The incidence of different fracture types in descending order were as follows: lateral malleolus fractures, medial malleolus fractures,posterior malleolus fractures and trimalleolar fractures. Pilon fracture was a common type of ankle fracture. Clinical outcome of open reduction and fixation for the treatment of posterior Pilon fracture with supporting plate was satisfied.
ABSTRACT
OBJECTIVE: To explore the clinical outcomes of open reduction and internal fixation by posterolateral and posteromedial approaches for treating posterior Pilon fractures in elderly patients. METHODS: Between August 2009 and August 2014, 20 elderly patients with posterior Pilon fractures were treated with open reduction and internal fixation by posterolateral and posteromedial approaches. There were 14 males and 6 females, aged from 66 to 83 years (mean, 72.7 years). The causes were falling injury in 11 cases and traffic accident injury in 9 cases. All the patients had lateral malleolus and medial malleolus fractures. The time from injury to operation was 7-14 days (mean, 8.6 days). The posterolateral incision was made to expose the posterolateral bone fragments of posterior malleolus and lateral malleolus fracture, and the posteromedial incision was made to expose the posteromedial fracture fragments of posterior malleolus and medial malleolus fracture. After reduction, fracture was fixed with locking plate or cannulated screw. All the patients began to functional exercise at 1 day after operation. RESULTS: The operation time was 60-110 minutes (mean, 92 minutes). The incisions healed primarily in all patients. There were no complications of incision dehiscence, infection, implant exposure, and nerve damage. No irritation sign of tendon was observed. All 20 cases were followed up for 12-18 months (mean, 13 months). The X-ray films showed that fracture healed at 3-9 months, with an average of 5.2 months. During follow-up period, no loosening or breakage of the implant was observed. The other patients could walk normally except 2 patients (over 80 years old) who could walk with crutch. According to American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, the results were excellent in 12 cases, good in 4 cases, and fair in 4 cases; the excellent and good rate was 80%. CONCLUSIONS: A combination of posterolateral approach and posteromedial approach for open reduction and fixation of posterior Pilon fractures can achieve satisfactory effect in elderly patients. It has the advantages of protecting ankle blood supply and avoiding the soft tissue necrosis and implants exposure.