Basic Anatomy And Clinical Application Of Surgical Treatment Of Posterior Pilon Fracture

Objective:1.The posterior malleolus involved in the posterior Pilon fracture was anatomized to explore the coverage of the inferior posterior tibiofibular ligament in Volkmann’s nodule;According to the Klammer classification of posterior Pilon fracture,the imaging measurements were compared with the anatomical data.According to the conclusions obtained,the posterior Pilon fracture was classified according to the specific fixation method of the posterior malleolus by Klammer.2.The anatomical part was used to draw conclusions and discuss the selection of fixation methods for posterior malleolus bone mass under each Klammer classification for posterior Pilon fracture,so as to achieve satisfactory long-term recovery.Methods:、1.19 ankle specimens provided by the Anatomy Teaching and Research Department of Qingdao University were carefully dissected and the PTIF was completely dissected.According to the experimental design,the boundary of the PTIF was marked and the relevant values were measured.Using CT tomography,89 posterior malleolus segments of posterior Pilon fracture were measured according to the Klammer classification,and the results were compared with anatomical measurements.2.Retrospective analysis of patients with posterior Pilon fracture admitted to our hospital from January 2014 to January 2018;Sixty-five patients treated by screw fixation of posterior ankle were selected as group A;A total of 46 patients with posterior Pilon fracture admitted to our hospital from January 2019 to June 2020 were selected,and the patients treated with bracing plate fixation of posterior malleolus bone mass were divided into group B.The operative time,blood loss,pain VAS score and fracture healing time were compared between the two groups.The Burwell-Charnley radiological evaluation criteria were evaluated on the second day after surgery and the American Association of Foot and Anchor Surgery(AOFAS)ankle-posterior foot score was used at the last follow-up.Results:1.The inferior posterior tibiofibular ligament is divided into superficial and deep layers,and there is a large variation of the posterior malleolus ligament called the posterior intermalleolus ligament.The posterior Pilon fracture was classified according to Klammer,and the size of the bone block was different under different classifications.The coverage of the posterior tibiofibular ligament in the Volkmann’s nodule fails to include the Klammer’s type I posterior malleolus mass.The posterior tibiofibular ligament extends beyond the posterior lateral malleolateral Klammer II bone mass in Volkmann’s nodule.The coverage of the posterior tibiofibular ligament in the Volkmann’s tubercle does not include the Klammer III posterolateral malleolateral bone mass.2.Klammer type I: fracture healing time,Aofas score and Burwell-Charnley score were basically the same in the two groups(P > 0.05),while operative time,blood loss and VAS score were better in the screw group(P < 0.05).Klammer II: operative time,blood loss,fracture healing time,AOFAS score and Burwell-Charnley score were basically the same(P > 0.05),but VAS score of screw group was lower;There were no significant differences in blood loss,fracture healing time and VAS score between the Klammer III group and the Klammer III group(P > 0.05),but the operative time,AOFAS score and Burwell-Charnley score were better in the support plate group(P < 0.05).Conclusion:1.The inferior posterior tibiofibular ligament is divided into shallow PITFL and deep PITFL.Posterior Pilon fracture of type Klammer I: Since the posterior malleolus is a monolithic coronal fracture with only a single bone mass,the mean length of the horizontal cross section of the bone mass X exceeds the mean of the JI measured by the specimen,for this type a hollow lag screw can be used for fixation.Posterior Pilon fracture of Klammer II: Since the mean length of the lateral cross section X of the posterolateral bone block is smaller than the mean length of the JI measured in the specimen,the bone block is restricted overall by PITFL and can be fixated with screws or plates in both the posterior and posterior medial segments.Posterior Pilon fracture in Klammer III: Since the mean length of the lateral cross section of the posterolateral bone mass is larger than the mean length of the JI measured in the specimen,the posterolateral bone mass as a whole exceeds the limit of the PITFL and there is a posterolateral bone mass,a plate for fixation of the posterolateral malleolus is an option.2.Klammer Type I lag screw fixation of the posterior malleolus can shorten the operative time,reduce the amount of bleeding,and relieve postoperative pain;For Klammer II,the posterior ankle can be fixed with lag screws or bracing plates,and there is no significant difference in surgical outcomes between the two.Klammer III fixation of the posterior malleolus with a bracing plate can shorten the operative time,increase the rate of anatomic reduction,and promote postoperative functional recovery of the ankle.