| Objectives:pilon fractures are difficult to treat because the distal tibial articular surface is smashed, the prognosis is poor, Riiedi-Allgower III fractures are even more difficult. Riiedi-Allgower III pilon fractures are always caused by high-energy injury, fractures are comminuted, articular surface and soft tissue are damaged seriously, surgical treatments are challenging and easy to cause complications. The common method are limited open reduction internal fixation combined with external fixation and open reduction internal fixation. Traditionally, ORIF uses anatomical plate to fix. With Locking Compression Plate (LCP) is widely used recently, it is also used in operations of pilon fractures. There are many reports of LCP used in operations of pilon fractures, and some scholars also have opposite opinion, but there is few reports discussing about the comparison of LCP and anatomic plate. The author had followed up the Ruedi-Allgower III pilon fracture patients who treated by LCP method or anatomical plate method, compared the clinic results,the radiology results,the operation time, fracture healing time and complication incidence to explore more appropriate method.Methods:60patients of Riiedi-Allgower III pilon fracture who were treated in Tianjin Hospital or Tianjin Port Hospital in February2006to June2011are divided into two groups. Group A is30patients treated by LCP method, group B is30patients treated by anatomical plate method. Group A:17males and13females. Aged from28to64, average is46.7years old. The causes of injury:4cases of automobile accidents,16cases of falling from high place,6cases of crushing by heavy object,4cases of sprains. Interval from injury to surgery time is6～17days, average is9.2days. Group B:18males and12females. Aged from23to66, average is47.5years old. The causes of injury:7case of automobile accident,13cases of falling from high place,7cases of crushing by heavy object,3cases of sprains. Interval from injury to surgery time is5～20days, average is9.6days. We took X-ray diagnosis to define Ruedi-Allgower type and three-dimensional CT scan to analyze detailed state of fracture. Operation performed when the edema of soft tissue had subsided, skin condition was stable and the wrinkles test was positive, about nine days after injury. If the patient also had fibula fracture, we firstly took the fibular posterolateral or posterior longitudinal approach to expose fracture and fixed it with plate. We restored fibular length and position of the talus; We also took anterior or anteromedial approach of distal of tibia, the gap between the incision of tibia and fibula was more than7cm. we did distal tibial articular surface reduction in the condition of direct vision and fixed tibia with distal tibial anatomical plate or LCP. All the patients were grafted with allograft or autograft. We raised the wounded limb properly after operation, used dehydration medications and prevent infection. Patients were encouraged to do ankle flexor extensor exercise after2weeks. According to the X-ray after6to10weeks, patients were allowed doing exercise with load less than30kg. When the X-ray and clinical signs showed the fractures had been healed, we encouraged patients to do exercise with full weight of load. We collected data with AGFA Operation System version3.0.18. We analyzed the operation time, fracture healing time and complication incidence. The clinical efficacy referred to the "pilon fracture clinical outcome evaluation standard, Tornetta,1993". Radiologic evaluation referred to the "pilon fracture reduction radiologic evaluation standard, Burwell Chamley,1965". We used SPSS17.0statistical package to analyze data, P<0.05meant statistically significant.Results:The average follow-up time is15.3months after operation. There is no statistically significant difference between the preoperative data of two groups (P>0.05). Average operation time of group A is44.60minutes, standard deviation is10.424. Average operation time of group B is56.43minutes, standard deviation is13.014. The operation time of two groups is statistically significant (P<0.05), group A is shorter than group B. Average healing time of group A is16.17weeks, standard deviation is3.495, Average healing time of group B is19.17weeks, the standard deviation is5.127. The healing time of two groups is statistically significant (P <0.05), group A is shorter than group B. Clinical efficacy, Tornetta evaluation, Burwell Chamley radiologic evaluation and Tornetta evaluation detailed index have no significant difference (P>0.05). There was1case of infection (3.3%) in Group A, no delayed union or nonunion occured. In group B,there were3cases of infection (10%),2cases of delayed union (6.7%),1case of implant fracture (3.3%),2cases of nonunion (6.7%).Conclusion:As the method of surgical treatment to Riiedi-Allgower Ⅲ pilon fractures, the LCP method has significantly shorten operation time and healing time than anatomical plate method. There are no significant difference in limb function rehabilitation and radiologic appearance between two methods. |
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