| Objective: Although pilon fracture is rare in lower limb fracture,it has always been one of the difficulties in clinical treatment,especially Rüedi-Allg?wer type Ⅲ Pilon fracture.Due to high-energy violence,the degree of crushing and displacement of joint flour is the greatest,the prognosis is poor,and the treatment method has not been determined.In this study,patients with Rüedi-Allg?wer type Ⅲ Pilon fracture were treated with transmalleolar adjustable external fixator combined with limited internal fixation and open reduction and internal fixation,respectively.The therapeutic effects of the two methods were compared,and the advantages and disadvantages were discussed in order to provide individual surgical ideas for clinical treatment.Methods: Using retrospective analysis,36 patients with Rüedi-Allg?wer type ⅢPilon fracture were divided into two groups: group A(n = 18)and group B(n = 18).18 patients in group A were treated with transmalleolar adjustable external fixator combined with limited internal fixation,and 18 patients in group B were treated with open reduction and internal fixation.the operation time was 10 ～ 14 days after injury and the follow-up was 6 ～ 18 months.The incidence of postoperative complications(skin necrosis,incision infection,osteomyelitis,delayed union or nonunion of fracture,traumatic arthritis)and clinical healing time of fracture were calculated between the two groups.The closed tissue injury was described by Tscherne classification system,the ankle function was evaluated by AOFAS scale,and the fracture reduction was evaluated by postoperative X-ray according to the scoring standard set by Burwell-Charnley.Results: The results of ankle function of 36 patients after operation according to AOFAS standard were as follows: excellent in 16 cases,good in 16 cases,fair in 3 cases,and poor in 1 case.The total excellent and good rate was 88.89% in group A,9 cases were excellent,8 cases were good,1 case was fair,and 0 case was poor.In group B,the excellent and good rate was 94.44%,7 cases were excellent,8 cases were good,2 cases were fair,and 1 case was poor,and the excellent and good rate was 83.33%.There was no statistical difference between the two groups(P > 0.05).The imaging data were evaluated according to the criteria set by Burwell-Charnley.The results showed anatomical reduction in 18 cases,functional reduction in 16 cases,poor reduction in 2 cases,and the total excellent and good rate was 94.44%.In group A,anatomical reduction was performed in 6cases,functional reduction in 10 cases and poor reduction in 2 cases.the excellent and good rate was 88.89%.In group B,anatomical reduction was performed in 12 cases,functional reduction in 6 cases,poor reduction in 0 cases,and the excellent and good rate was 100%.There was significant difference between the two groups(P < 0.05).It can be considered that the reduction quality of group B is better than that of group A.The average fracture healing time in group A and group B was 121.83 ±9.59 d and 144.89 ±12.69 d,respectively.There was significant difference in fracture healing time between the two groups(P < 0.05).It can be considered that the clinical healing time of fracture in group A is less than that in group B.The incidence of complications: there were 2 cases of postoperative complications in group A,and the incidence of complications in group B was11.11%.The incidence of complications in group B was 27.78% P > 0.05,and the difference was not statistically significant.Conclusion: For the patients with Rüedi-Allg?wer type Ⅲ Pilon fracture,both of the two surgical methods can fix the fracture end and restore the limb length,but compared with the open reduction and internal fixation,the application of transmalleolar adjustable external fixator combined with limited internal fixation can effectively reduce the injury to skin and soft tissue,reduce the incidence of early incision complications after operation,and the satisfaction rate of patients’ function recovery is higher. |
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