Two Different Ways Of Fixation For The Medial-extension Type Of Posterior Pilon Fractures

Objective:To analyze the characteristics and the mechanism of injury of the medial-extension type of posterior pilon Fractures,and compare and evaluate the curative effects of posterior tibial plate fixation and posterior forward hollow nails fixation on the treatment of the medial-extension Type of Posterior pilon Fractures.Methods:We proceed a retrospective study which is a detailed collection for a total of 60 patients with the medial-extension type of posterior pilon fractures who had been treated from September 2014 to September 2016 in our clinical center.The posterior tibial plate fixation group and the posterior forward hollow nail fixation group are divided according to the fixed way.The operate time,Intraoperative bleeding,total weight loading time,fracture healing time were compared between the two groups.The postoperative X-ray radiography was used to evaluate the reduction of articular surface by Burwell-Charnley radiology.The ankle joint function was evaluated by the American Ankle Surgery Association(AOFAS)score.The postoperative complications of the two groups were compared and analyzed.Results:1.There was no statistically significant difference in the time of operation(min)[plate group 66.52 ± 8.61,nail group 72.4 ± 2.65,P > 0.05] and the amount of Intraoperative bleeding(m L)[plate group 401±73,nail group 374±85,P>0.05).2.In the posterior tibial plate fixation group,the total weight loading time and fracture healing time were shorter than that of the hollow nail fixation group[(8.58±0.708)vs(11.11±1.502))],the difference was statistically significant(P<0.05).3.The post operation Burwell-Charnley radiology plate group(96.97%)was superior to the hollow nail group(85.19%),two group are both up to 85%.4.3 months follow-up AOFAS score in the plate group were better than the hollow nail group[(86.00 ± 3.775)vs(81.37 ± 4.916)],the difference was statistically significant(P < 0.05),however,There was no significant difference between the two groups in last follow-up AOFAS score[(87.36±3.121)vs(85.74±3.580)].Conclusion:1.The two group are no statistically significant difference in operating time and the amount of intraoperative bleeding,the plate group are superior to the hollow nail group in total loading time and fracture healing time.2.The post operation Burwell-Charnley radiology plate group was superior to the hollow nail group,two group are both up to 85%.3 months follow-up AOFAS score in the plate group were better than the hollow nail group,the difference was statistically significant(P < 0.05),however,There was no significant difference between the two groups in the last follow-up AOFAS score.3.The medial-extension type of posterior pilon Fracture is combined by vertical violence and rotational violence,which illustrates a complex damage mechanism.It is worth to be studied in depth.Reasonable surgical incision can reduce the probability of occurrence of surrounding soft tissue complications,Two kinds of internal fixation methods for the treatment of the medial-extend posterior pilon fracture can obtain relatively satisfactory curative effect,However,The posterior tibial plate fixation is more beneficial to early weight loading,functional exercise and promotion of fracture healing.