| Objective:Pilon fractures belong to the distal tibial joint fractures,including involving the articulation of the articular surface and above the metaphyseal fractures,the treatment effect directly affects the function and stability of the ankle joint.At present,the most commonly used pilon fractures are Ruedi-Allogwer typing and AO tpying.But AO typing was raised for the distal tibial fractures,which type A and part of the B type does not belong to pilon fractures,only most of the C-type pilon fracture.The treatment of pilon fractures is mainly due to the soft tissue and fractures.the greater the violence is suffered by the limb,the greater the degree of fracture,the worse the soft tissue conditions,the greater the difficulty of treatment,the higher the incidence of postoperative complications.The Ruedi-Allogwer typing is mainly based on the size of the injury energy,the degree of fracture and the presence of compression,which is helpful to compare the clinical effect of the same type of pilon fracture in different surgical methods.Ruedi-Allogwer type III refers to the comminuted compression fractures of tibial distal articular surface and its upper metaphyseal,because of postoperative complications,in the long term this type of fracture is controversial surgical choice.The focus of the debate is mainly on these two ways: staging open reduction and internal fixation(staging ORIF)and external fixation combined with limited open reduction and internal fixation(limit ORIF).Both surgical methods are designed to minimize anatomical reduction of the articular surface while minimizing re-injury of the soft tissue and for early ankle activity.But there is still no sufficient evidence to show the clear advantages and disadvantages of both surgical methods.In clinical practice,when soft tissue conditions are poor,fractures is serious,we always based on experience to choose the surgical method.Therefore,the purpose of this study is to compare the two groups of patients with complex type III pilon fractures by using open reduction and internal fixation and external fixation combined with limited open reduction and internal fixation.Comparative incidence of postoperative complications and ankle function recovery,to arrive at the advantages and disadvantages of the two methods of operation,provide a basis for clinicians in the choice of type III complex pilon fractures of the way.Methods:The clinical data of 70 patients with ruedi-Allogwer III pilon fractures diagnosed at the Second Hospital of Shanxi Medical University from January 2012 to December2015 were divided into two groups: staging and reduction of internal fixation(group A,35 cases)and external fixation combined with limited open reduction and internal fixation(group B,35 cases).The incidence of postoperative complications,fracture healing time,degree of reduction and ankle function were compared between the two groups.Then we make a statistical analysis,clear the relationship between the observed indicators,summe up the advantages and disadvantages of the two treatment programs.Results:1.All patients were followed up for 7 to 15 months(an average of 8.6 months).All patients had no bone nonunion and all fractures were healed.A group of fracture healing time of 14-21 weeks,an average of 16.6 weeks;B group of fracture healing time of 13-19 weeks,an average of 17.1 weeks.There was no statistically significant difference in fracture healing time between the two groups(P> 0.05).2.The results of postoperative follow-up showed that the infection rate was 8.60%in group A and 5.70% in group B.There was no statistically significant difference in the incidence of postoperative infection between the two groups(P> 0.05).3.Mazur ankle function and symptom evaluated in group A:excellent: 17 cases,good: 13 cases,can be: 4 cases,poor: 1 case,excellent rate was 85.71%.Mazur ankle function and symptom evaluated in group B: excellent: 15 cases,good: 11 cases,can be: 7 cases,poor: 2 cases,excellent rate was 74.28%.There was no statistically significant difference in the evaluation of Mazur ankle function and symptom between the two groups(P> 0.05).4.The two groups were treated with X-ray Burwell-Charnley score: group A:anatomical reduction: 27 cases,acception 7 cases,poor 1 case;group B: anatomical reduction: 20 cases,acception 9 cases,poor: 6 example.The scores of the two groups were statistically statistically different and group A was better than group B(P <0.05).5.Ruedi-Allogwer III type Pilon fractures' Burwell-Charnley score and Mazur ankle score has some relevance,there was statistically significant difference(P<0.05).Conclusion:For closed soft tissue good conditions pilon fractures,correctly grasp the timing of surgery,staging ORIF can get very good clinical results.For open fractures,poor soft tissue conditions pilon fracture,the use of external fixation combined with limited open reduction and internal fixation,the clinical effect is satisfactory. |
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