Use of an articulated external fixator for high energy Pilon fractures / 中华骨科杂志

ABSTRACT

Objective To introduce the experience of treating high energy P il on fractures with an articulated external fixator. Methods From March to June 20 01, twelve patients (13 fractures) suffered from high energy Pilon fractures wer e treated with an articulated external fixator (Orthofix, Italy). The fixators w ere placed medially across the ankle joint, if necessary, fixation of fracture w as enhanced with combination of limited internal fixation. The main injury was c aused by traffic accident and high altitude dropping. The distal two pins were i nserted into the neck of the talus and the tuberosity of the calcaneus so that s ubtalar joint was treated as an axis during ankle movement. At approximately pos toperative two weeks, the articular hinge was released and the patient began ank le exercises. The clinical outcomes and complications were investigated and the postoperative of X-ray examination of ankle were also evaluated. Results Twelve patients were followed up with a mean period of 12 months. No infections of woun d and pin sites and no neurovascular complication was found. According to Teeny & Wiss ankle joint scoring system, the symptom and functional evaluation of the ankle was scored from 74 to 94 (average 87). Clinical results demonstrated 2 exc ellent, 7 good, 4 fair. Quality of reduction of the articular surface showed 7 g ood and 6 fair using system of Marsh classification of reduction of the articula r surface of the ankle. Conclusion External fixation with an articulated fixator combined with limited internal fixation is a satisfying technique to treat high energy Pilon fractures. This technique helps to effectively decrease both wound and bone healing complications. With advantage of restoring anatomical articula r surface and enabling early ankle joint motion, this technique also helps to pr event ankle joint stiffness after fixation. The short term result of the above-m entioned fixation is encouraging.