An analysis of the clinical outcomes of open reduction and internal fixation by posteromedial approach for posterior Pilon fractures

LIN Wei-long; HU Hai-bo; LI Ping-sheng; LIN Guo-ye

doi:10.3969/j.issn.2095-252X.2015.06.012

Abstract：Objective To investigate the clinical outcomes of the posteromedial approach for posterior Pilon fractures.Methods The clinical data of 132 patients with posterior malleolar fractures who underwent surgical treatment from July 2010 to July 2013 were retrospectively analyzed. Based on the imaging data on admission, 27 patients with complete information were diagnosed with posterior Pilon fractures and were treated by open reduction and internal ifxation ( ORIF ) through a posteromedial approach. There were 18 males and 9 females, whose mean age was 47.8 years old ( range: 19-76 years ). The injury mechanisms included falling injuries in 13 patients, sprain on the lfat ground in 7 patients and motor vehicle accidents in 7 patients. Lateral malleolus fractures and articular cartilage surface subsidence were found in all the patients. Preoperatively, all the patients had foot and ankle swelling, deformity and restricted movement. The posteromedial approach was used in ORIF with screws or plates for all the fractures. The mean period from injury to surgery was 5.7 days ( range: 1-14 days ). Wound and fracture healing was recorded at regular intervals postoperatively. Functions were evaluated according to the American Orthopaedic Foot and Ankle Society ( AOFAS ) Ankle Hindfoot Scale.Results All the 27 patients were followed up for a mean period of 21.8 months ( range: 13-36 months ). All the incisions were primarily healed. The X-ray films at 2 days after the operation showed anatomical reduction in 25 patients with no articular stepoff in the distal tibia and normal width of the medial ankle mortise and good reduction in 2 patients with the articular stepoff in the distal tibia <1 mm and widening of the medial ankle mortise <1 mm. The rate of anatomical reduction was 92.6%. All the patients achieved fracture union, and the mean healing time was 16.3 weeks ( range: 13-22 weeks ). The mean AOFAS Ankle Hindfoot Scale score was 88.9 points ( range: 76-100 points ) in the latest follow-up. The clinical outcomes were excellent in 19 patients and good in 8 patients, and the excellent and good rate was 100%.Conclusions The whole posteromedial fracture fragment can be completely exposed in the treatment of posterior Pilon fractures using the posteromedial approach, and it becomes easy to perform fracture reduction and fixation. The clinical outcomes are satisfactory. Therefore, the posteromedial approach should be preferred for posterior Pilon fractures.