Diagnosis and treatment of anterior pilon fracture / 中华创伤杂志

ABSTRACT

Objective To investigate the diagnosis,operation characteristics and clinical effect of anterior Pilon fracture.Methods A retrospective analysis was carried out to analyze 13 patients who had been treated for anterior pilon fracture from September 2012 to March 2014.All had fresh closed fracture.Mean age was 39.8 years (range,18-61 years).Injury resulted from high falls in 11 patients and falls in 2 patients.According to the preoperative imaging manifestations and four column fracture classification,the fracture type was mainly anterior column fracture.All underwent open reduction and internal fixation with buttress plates,and allograft bone was performed in 8 patients.At the last followup,American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and visual analogue scale(VAS) were employed for clinical evaluation.Results Mean period of follow-up was 15.7 months (range,12-30 months).Mean AOFAS score was 91.38 points (range,74-100 points).Excellent results were found in 10 patients,good in 2 and fair in 1,with the excellent-good rate of 92％.Mean VAS score was 1.08 points (range,0-3 points).Traumatic arthritis occurred in 1 patient.Skin necrosis occurred in 1 patient,and was cured by dressing change.There were no complications such as infection,refracture or implant failure.Conclusions Mechanism of injury in anterior pilon fracture is vertical violence when the foot in dorsiflexion position.Imaging findings are mainly characterized by the compression in anterior articular surface of the distal tibia,which is often implicated in the anterior medial malleolus but in part is combined with lateral malleolus fracture.The fracture is the result of high energy injury,and can be diagnosed by mechanism of injury and imaging manifestations.Through anterior approach,open reduction and internal fixation with buttress plates plus allogenic bone grafting obtain satisfactory outcomes.