Buttress plate fixation alone or combined with hollow screws for treatment of posterior tibial pilon fractures

Abstract

Objective To study the effect of buttress plate fixation alone or combined with hollow screw fixation of posterior tibial pilon fractures. Methods A retrospective case series analysis was made on 28 cases of posterior tibial pilon fractures admitted from February 2010 to February 2015. There were 18 males and 10 females, aged from 20 to 65 years (mean, 40.5 years). Klammer classification was type 1 in 10 cases, type 2 in 12 and type 3 in 6. Denis-Weber classification was type B in 26 cases and type C in 2 cases. Fourteen cases had buttress plate fixation, 4 hollow screw fixation through posterior-anterior approach, and 10 buttress plate fixation combined with hollow screws. Fracture reduction, function recovery, incidence of complications, and range of motion of ankle joint were detected after operation. American orthopedic foot and ankle society (AOFAS) ankle-hindfoot scale, Kellgren-Lawrence grading for osteoarthritis and visual analogue scale (VAS) were applied to evaluate clinical efficacy at the final follow-up. Results Operation incision healed by first intention. Anatomic reduction and rigid stabilization were noted in all, except that two cases presented one millimeter gap in the posterior articular surface. Duration of follow-up was 13 to 36 months (mean, 20.6 months). Time to fracture healing was 6 to 10 weeks after operation (mean, 7.5 weeks). No deep incision infection or lower extremity deep venous thrombosis occurred after operation. One case developed epidermal necrosis, and resulted in scar healing by strengthening the dressing. One case developed fibula tendon irritation symptom, and disappeared after the removal of internal fixation. One case developed skin irritation symptom because of the overlong screw, and disappeared after the removal of the screw. One case developed osteoarthritis because of the mild displacement of fracture bone in the process of fixation. One case developed toe flexion deformity two months after operation. AOFAS scale was (88.6±6.4)points at the final follow-up, and differed significantly from that before operation [(32.2±1.3)points] (P<0.05). Kellgren-Lawrence grading zero was noted in 24 cases, grading Ⅰ in 2, grading Ⅱ in 1, and grading in 1. VAS was (0.8±0.3)points at the final follow-up, and differed significantly from that before and after operation [(8.5±1.5)points and (6.3±1.0)points, respectively] (P<0.05). Conclusion Anatomical reduction of posterior tibial pilon fractures can be received by buttress plate fixation alone or combined with hollow screws, which can reduce the complications and attain excellent clinical outcomes. Key words: Tibial fractures; Ankle; Fracture fixation, internal