A Comparative Study Of Indirect Reduction Cannulated Screw Versus Buttress Plate Fixation In The Treatment Of Yu Guangrong Type Ⅰ And Ⅱ Pilon Fractures

Objective: To compare the clinical outcomes of indirect reduction cannulated screw versus buttress plate fixation in the treatment of Yu Guangrong type Ⅰ and Ⅱ Pilon fractures.Methods: A retrospective study was conducted on the patients with Yu Guangrong type Ⅰ and Ⅱ posterior Pilon fractures treated in the first affiliated Hospital of Chongqing Medical University from January 2015 to June 2019.According to the inclusion and exclusion criteria,there were 39 cases.According to the different treatment methods,the patients were divided into two groups: indirect reduction cannulated screw fixation group(group A),and posterolateral buttress plate fixation group(group B).In group A,there were 11 males and 7 females with an average age of(42.5 ±6.8)years,6 cases of Yu Guangrong type Ⅰ and 12 cases of Yu Guangrong type Ⅱ,and the average follow-up time was(15.2 ± 1.2)months(13 ～ 18months).In group B,including 13 males and 8 females,with an average age of(42.2 ± 6.1)years,9 cases of Yu Guangrong type Ⅰ and 12 cases of Yu Guangrong Ⅱ,and the average follow-up time was(14.6 ± 1.4)months(12 ～ 18 months).Standardized follow-up was performed at 1 month,3months,6 months,12 months and 18 months after operation.The long-term function of ankle joint was evaluated by AOFAS score,the average loss of dorsiflexion(LDF)was used to evaluate ankle movement.Results: The average operation time in group A [(114 ± 6)min] was significantly shorter than that in group B [(139 ± 8)min](Z=-8.412,P<0.001).Clinical healing was achieved in both groups within 6 months of follow-up,and there was no secondary loss of reduction and failure of internal fixation.All the patients in group A achieved satisfactory reduction.In group B,there were 1 patient with toe flexion contractrue deformity,2patients with lateral foot paresthesia and 1 patient with incision infection.During the last follow-up,no significant manifestations of post-traumatic arthritis were observed in both groups.There was no significant difference in AOFAS score and joint average LDF between group A and group B at 6months,12 months and the last follow-up(P > 0.05).Conclusions: Satisfactory clinical effects can be obtained after the treatment of posterior pilon fracture with the two treatment methods.In the cannulated screw group,closed reduction and minimally invasive surgery can be achieved.At the same time,there are higher requirements for surgical techniques.In the buttress plate group,fracture fragments can be anatomically reduced under direct vision,but the operation is more traumatic.