The Clinical Study On Open Reduction And Internal Fixation In Treatment Of High-energy Pilon Fractures

Objective: To explore the feasibility of treating high-energy pilon fractures by delayed open reduction and internal fixation. Methods: We retrospectively reviewed the follow-up records of 58 patients with high-energy pilon fractures who were treated in departments of the orthopaedics of Shandong University of Traditional Chinese Medicine Affiliated Hospital from March,2003 to May,2008 and the follow-up period ranged from 10 to 24 moths(means 15.3 moths). 58 cases were divided into two groups according to the period between injured and operated: delayed open reduction and internal fixation group(referred to as Group A) and early open reduction and internal fixation group(referred to as Group B). 30 patients were included in group A who were operated on range from 10th to 21st day after injury when the soft tissue injuries healed, and 28 patients were included in group B who were emergent operated on in 8 hours after injury. To respectively compared the tissue complications, quality of fractures reduction, time for bone union and function of suffering ankle joint by statistical analysis. Results: The incidence of postop soft tissue complications of group A was significantly lower than that of group B, and the function of suffering ankle joint of Group B was superior to that of group B; while in the fracture healing time and quality of fractures reduction, there were no significant difference in the two groups. Conclusion: The key of surgical treatment of high-energy pilon fractures are both soft tissue protection and the choice of appropriate surgical timing. Early open reduction and internal fixation even in 8 hours have still high risk, while delayed open reduction and internal fixation is a viable approach.