Clinical outcomes of distal tibia posterior locking plate internal fixation for posterior Pilon fractures with lateral malleolus fracture through a combined posterolateral approach

Abstract

Objective To explore the surgical method and the efficacy of posterolateral approach combined with locking plate for treatment of posterior Pilon fracture with lateral malleolus fracture. Methods We retrospectively analyzed the clinical data of 59 patients with posterior Pilon fracture complicated by lateral malleolus fracture treated in our hospital from January, 2014 to January, 2018, including 33 male and 26 female patients aged 21-69 years (mean 46.8 years). Among these cases, the fractures resulted from sprains in 29 cases, falling in 21 cases and traffic accidents in 9 cases; the fractures occurred on the left side in 31 cases and on the right in 28 cases. According to YU Guangrong's classification, 19 patients had type Ⅰ, 24 had type Ⅱ and 16 had type Ⅲ fractures. All the patients underwent distal tibia posterior locking plate internal fixation through a combined posterolateral approach, and the postoperative complications, bone healing time and fracture reduction were recorded; the ankle function was assessed based on the American Orthopaedic Foot and Ankle Society (AOFAS) score. Results The patients were followed up for 12 to 30 months (mean 18 months) after the operation. According to the Burwell-Charnley's criteria, anatomical reduction was achieved in 46 cases and good reduction in 9 cases, with an excellent and good reduction rate of 93.2%. The mean healing time of the fracture was 11 weeks (9-15.5 weeks). The mean VAS scores at rest, in motion and in weight bearing were 0.54, 0.77 and 1.31, respectively. The ankle function, as evaluated according to AOFAS scores, was excellent in 45 cases, good in 11 cases, and acceptable in 3 cases, with an excellent and good function rate of 94.9%. No such complications as infection, failure of internal fixation, nonunion or malunion occurred during the follow-up. Conclusion The posterolateral approach combined with the locking plate, which has a clear surgical approach to allow flexible operation and reliable fixation, can achieve satisfactory clinical effect for treatment of posterior Pilon fracture with lateral malleolus fracture and promotes early functional recovery.

Keywords

• ankle
• posterior pilon fracture
• posterolateral approach
• incision reduction
• internal fixation