The Clinical Efficacy and Prognostic Evaluation of Locking Compression Plate in the Treatment of Pi-lon Medial Column Fracture Based on Four-column Theory

Wang Zhe; Li Shenglong; Tang Xin

Abstract：Objective To discuss the clinical efficacy and prognostic evaluation of locking compression plate in the treatment of Pilon medial column fracture with the guidance from four-column theory.Methods We retrospectively an-alyzed 27 cases of patients from April 2013 to April 2015 with the admittance to the department of Orthopedic Trauma in the first affiliated hospital of Dalian Medical University,diagnosed as Pilon medial column fracture and underwent surgical therapies by locking compression plate (LCP),aging from 16 to 78,47.80 on average.There were 20 male cases and 7 female cases.1 2 sides were on the left side,1 7 sides were on the right side,2 cases were on both side.According to AO/OTA classification,there were 14 sides of type 43B2,7 sides of type 43C1,3 sides of type 43C2,5 sides of type 43C3.On the basis of Ruedi-Allgower classification,there were 7 sides of Type I,13 sides of Type Ⅱ,9 sides of TypeⅢ.Medial columns of all cases were interfered based on four-column theory.24 sides were close fractures,while 5 sides were open injuries.4 sides were classified to GustiloⅡ,1 side GustiloⅢc.26 sides were treated by open reduction inter-nal fixation through distal tibial medial approach and 3 sides by close reduction external fixation by LCP.Patients were required for knee joint functional practice with non-weight bearing in post-operative 3 days,ankle joint of extension and flexion practice in post-operative 2 weeks.Its clinical efficacy was respectively assessed on the basis of Burwell-Charnley radiograhic standard,Hind-foot and ankle scoring system by AOFAS and Tornetta clinical evaluation standard.Results The operative time was (90.52±12.75)min,mean intra-operative blood loss was (77.25±3.27)mL and mean length of stay was (8.32±1.28)d.All cases had been followed up from 1 to 7 months.Incision infection occurred in 1 cases af-ter operation,the wound healed 1 weeks after debridements and antibiotic therapies.There was no complications for therest cases shown as incision infection,suppuration,deep vein thrombosis,peripheral soft tissue necrosis,delayed union/union or osteomyelitis.The excellence rate of reduction was 89.60% (26/29).Post-operative follow-up indicated that an-kle joint evaluated by AOFAS ankle-posterior foot scoring system scored from 68 to 92.The clinical excellence rate of Pilon fractures was 86.20%(25/29).Conclusion As for Pilon fractures with medial column interfered,it can reduce soft tissue injuries and lower the incidence of postoperative complications to obtained an expected clinical curative effect and prognostic evaluation under the guidance from four-column theory to conceive a suitable surgical strategy.