Open reduction and osteotomy for old pilon fracture / 中华创伤杂志

ABSTRACT

Objective@#To investigate the efficacy of open reduction and osteotomy combined with internal fixation to reconstruct the distal tibial articular surface in the treatment of old pilon fracture.@*Methods@#A retrospective case series study was conducted to analyze the clinical data of 20 patients with old pilon fracture admitted to Zhengzhou Orthopaedic Hospital from July 2014 to February 2018. There were 14 males and six females, aged 21-45 years, with an average of 31.5 years. According to AO classification, there were four patients with C1 type, seven with C2 type and nine with C3 type, all of which were closed fractures. Eleven patients received non-operative treatment while nine patients underwent surgeries. After the surgery, malunion was seen in eight patients, and incomplete union in 12 patients. There were eight patients with posterior articular surface collapse of distal tibia, seven patients with anterior articular surface collapse of distal tibia, three patients with varus deformity and two patients with valgus deformity. All patients were treated with open reduction and osteotomy with internal fixation to reconstruct the articular surface of distal tibia. The time of fracture healing was recorded, and the Visual Analogue Scale (VAS), ankle flexion and extension range of motion, and AOFAS ankle-hind foot function score were compared before and at the last follow-up. The complications were recorded.@*Results@#All patients were followed up for 7-36 months, with an average of 26.4 months. Fracture healing time was 3-7 months, with an average of 4.1 months. At the last follow-up, VAS, ankle metatarsal flexion, dorsal extension and AOFAS scores were significantly improved compared with those before operation [(1.9±1.0)points vs. (6.6±1.4)points, (31.6±2.4)° vs. (18.5±4.4)°, (25.7±2.7)° vs. (15.6±2.7)°, (79.6±7.3)points vs. (42.6±5.6)points] (P<0.05). One patient developed severe ankle traumatic arthritis 7 months after operation and underwent fusion of ankle joint.@*Conclusion@#For old pilon fracture, open reduction and osteotomy to reconstruct the distal tibial articular surface can effectively relieve pain, improve joint mobility and restore ankle function.