Case-control study on calcaneal traction and external fixator fixation of fractional delayed surgery for type C Pilon Fracture

Abstract

To compare clinical effects of calcaneal traction and external fixator fixation of fractional delayed surgery in treating type C Pilon fractures. From January 2012 to December 2017, clinical data of 45 patients with tibial Pilon fractures were respectively analyzed. There were 24 patients in traction group, including 16 males and 8 females, aged from 21 to 57 years old with an average age of (38.6 ±10.5) years old; 18 patients caused by falling down, 6 patients caused by traffic accident; 15 patients on the left side and 9 patients on the right side; according to AO/OTA classification, 3 patients classified type C1, 9 patients classified type C2 and 12 patients classified type C3; treated by calcaneal traction on the first stage, and open reduction and internal fixation on the second stage. There were 21 patients in external fixation group, including 15 males and 6 females, aged from 19 to 58 years old with an average age of (37.8 ±11.2) years old; 17 patients caused by falling down, 4 patients caused by traffic accident; 11 patients on the left side and 10 patients on the right side; according to AO/OTA classification, 2 patients classified type C1, 8 patients classified type C2 and 11 patients classified type C3; treated by external fixator on the first stage, and open reduction and internal fixation on the second stage. All patients were closed fracture. Preoperative waiting time, hospital stays, operative time, postoperative complications, fracture reduction and healing time between two groups were compared, VAS score was used to evaluate relief of pain before internal fixation on the second stage, Burwell-Charnley radiological evaluation criteria was applied to evaluate fracture reduction after internal fixation, AOFAS score was used to evaluate recovery of ankle joint function. There were no statistical difference in operative time, following-up time and fracture healing time between two groups. VAS score before internal fixation in traction group was 3.73± 0.87, while in external fixation group was 2.67±0.69, there was statistical difference between two groups. Preoperative waiting time, and hospital stays in traction group were (9.20±1.40) d ,(12.30±3.60) d; while in external fixation group were (7.60± 1.50) d ,(10.80±2.60) d; and had significant difference between two groups. There was no difference in complications between two groups. According to Burwell-Charnley radiological evaluation criteria, 20 patients obtained anatomical reduction, and 4 patients received normal reduction in traction group; 18 patients obtained anatomical reduction, and 3 patients received normal reduction in external fixation group; while without difference between two groups. There was no difference between two groups in AOFAS score. For type C Pilon fractures, one-stage calcaneus traction or temporary external fixation also could achieve temporary fixation and provide better soft tissue conditions for the second stage internal fixation, and could receive better ankle joint function after internal fixation. The operation of calcaneus traction is simple, while external fixation may be increase the number of operation times, but external fixation has more advantages in reducing preoperative pain, shortening preoperative waiting days and hospitalization time than traction.