The Multivariate Analysis Of The Treatments For TypeⅡ/Ⅲ Pilon Fractures

ObjectiveDepending on comparing the clinical results of different surgical methods and time points in the treatment of Pilon Ⅱ、Ⅲfractures,we believe that our study could provide orthopedists with a reasonable choice about the operation time and methods. MethodsAccording to the standards, 80 cases of Pilon fractures, treated in March 2010 to September 2015, were selected into the groups. Among them, the early operation group of external fixator combined with limited internal fixation contained 21 cases(group A), the early operation group of open reduction and internal fixation with locking plate contained 18 cases(group B), the delayed operation group of open reduction and internal fixation with locking plate contained22 cases(group C), the delayed operation group of external fixator combined with limited internal fixation contained19 cases(group D). Several indices were compared between four groups, which consisted ofoperation time, intraoperative blood loss,postoperative skin necrosis and infection, the healing of fracture, ankle joint function score, etc. Result12 to 24 months(average 19) follow-up were accomplished in four groups, according to the ankle function score designed by Mazur in 1979, the satisfactory rate of four groups were groupA 81%, groupB 33.3%,groupC 81.8%,groupD 36.8%. There were statistical significance between groupA and B, groupA and D, groupB and C, as well as groupC and D(P<0.05), while no statistical significance were found between group A and C and group B and D. The proportion of patients without complications in four groups were groupA 66.7%, groupB22.2%、groupC 72.7%、groupD 57.9%. The groupA and groupC showed the best performance, groupD’s performance was poor, whereas the groupB showed the worst performance. In regard to the operation time:the external fixator combined with limited internal fixation group was shorter than internal fixation group, and early surgical groups were shorter than the delay surgical groups. As far as the bleed loss during the operation: external fixator combined with limited internal fixation group was less than internal fixation group,early external fixator combined with limited internal fixation group was less than the delayed external fixator combined with limited internal fixation group, and there was no statistical significance between the early internal fixation surgery group and delayed internal fixation surgery group. ConclusionSoft tissue condition is the main factor to decide the surgical method and operation timing. The method of external fixator combined with limited open reduction and internal fixation is applicable to patients who suffer open wounds or many hemorrhagic bullae,early debridement and external fixator combined with limited internal fixation is appeal to patients with large open wounds, while the delayed open reduction and internal fixation should apply to closed fractures without hemorrhagic bullae.