Effects of different surgical approaches on ankle function,inflammation and stress state in patients with AO type C pilon fractures

WANG Hong-chao; ZHANG Ming-lun; GUAN De-qiang; CHEN Zhan-wei; SUN Tian-ci; CHEN Jian

doi:10.3969/j.issn.2095-252X.2025.03.008

Abstract：Objective To analyze the effects of different surgical approaches on the American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot score,inflammation and stress state of patients with AO type C pilon fractures.Methods The clinical data of 100 patients with AO type C pilon fractures treated at the hospital from January 2020 to January 2023 were retrospectively analyzed.According to different surgical approaches,the patients were divided into group A(n=50,open reduction and internal fixation via anterolateral approach)and group B(n=50,open reduction and internal fixation via anterolateral approach combined with medial minimally invasive approach).Perioperative related indicators,AOFAS ankle-hindfoot scores,inflammatory indicators[C-reactive protein(CRP),interleukin-6(IL-6)and tumor necrosis factor alpha(TNF-α)],stress indicators[serum norepinephrine(NE),epinephrine(E)and cortisol(Cor)],and the incidence rates of complications in the two groups were recorded.Results Compared with group A,intraoperative blood loss of group B was less[(75.18±8.22)ml vs.(86.94±9.46)ml]and fracture healing time of group B was shorter[(95.50±8.52)d vs.(101.50±9.07)d],with statistically significant differences(P<0.05).At 3 and 6 months after surgery,AOFAS ankle-hindfoot scores of group B were higher than those of group A[(63.30±7.08)vs.(58.38±6.21),(91.34±8.36)vs.(85.68±8.01)],and the differences were statistically significant(P<0.05).At 1 month after surgery,VAS score of group B was lower than that of group A[(1.39±0.18)vs.(2.11±0.25)],and the differences were statistically significant(P<0.05).There were no statistically significant differences in serum CRP,IL-6,TNF-α,NE,E and Cor levels between the two groups before surgery(P>0.05).On day 1 after surgery,the levels of CRP,IL-6 and TNF-α in group B were lower than those in group A[(6.85±0.45)mg/L vs.(7.33±0.57)mg/L,(7.22±0.85)ng/L vs.(9.25±0.96)ng/L,(18.98±2.19)ng/L vs.(25.48±3.27)ng/L].On day 1 after surgery,the levels of NE,E and Cor in group B were lower than those in group A[(123.58±13.56)ng/ml vs.(152.37±16.25)ng/ml,(102.38±11.38)ng/ml vs.(162.26±17.56)ng/ml,(20.39±2.42)U/ml vs.(26.36±3.21)U/ml](P<0.05).The incidence of complication in group B(2%)was lower than that in group A(10%)(χ2=2.837,P=0.204).Conclusions Applying anterolateral approach combined with medial minimally invasive approach can achieve significant clinical effects in the treatment of AO type C pilon fracture.It can promote ankle function recovery,and reduce postoperative inflammatory and stress reactions.