Clinical outcome of open reduction and internal fixation through posteromedial approach for posterior Pilon fracture

HUANG Xiao-nan; HAO Lei; SHEN Ming-jie; FAN Meng

Abstract：Objective To evaluate the clinical outcome of open reduction and internal fixation through pos -teromedial approach for the treatment of posterior Pilon fracture .Methods Data of 139 patients with posterior mal-leolar fractures from Apr .2008 to Apr.2013 in our hospital were retrospectively analyzed .Among them,29 patients whose X ray and CT scan showed posterior Pilon fracture were involved in this study .There were 19 males and 10 females with the mean age of 46.3 years(ranged from 21 to 74 years).The mechanism of injury included falling in 12 patients,strain in 10 patients,and motor vehicle accidents in 7 patients.All patients were accompanied with lat-eral malleolus fracture and articular cartilage collapse .All patients had foot and ankle swelling ,deformity and re-stricted movement .Open reduction and internal fixation through posteromedial approach was applied .The period from injury to surgery was 1 to 11 days,with an average of 5.3 days.The condition of wound and fracture healing was regularly recorded after operation .Function was evaluated according to the AOFAS Ankle Hindfoot Scale .Re-sults All 29 patients were followed up for 15 to 47 months(mean,24.6 months).The incisions in all patients re-ceived primary healing .Postoperative X ray showed anatomical reduction in 26 patients with no articular collapse and normal ankle mortise and 1 mm of collapse and 1mm widening of the medial ankle mortise in 3 patients.The rate of anatomical reduction was 89.7%(26/29).All patients achieved fracture union and the healing time ranged from 12 to 21 weeks(mean,15.2 weeks).The AOFAS Ankle Hindfoot Scale were 81 to 100 points(mean,89.5 points).There were excellent outcomes in 21 patients and good in 8 patients,and the excellent and good rate was 100%.Conclusion Treatment of posterior Pilon fracture through posteromedial approach can achieve a good sur -gical field and easy anatomical reduction with satisfactory clinical outcome .Therefore,the posteromedial approach should be the preferred approach for posterior Pilon fractures .