Combined modified posteromedial and anterior approaches for the treatment of Rüedi-Allgöwer type III Pilon fractures

Abstract

Objective To explore the operation indication and clinical effect of combined modified posteromedial and anterior approaches for the treatment of Ruedi-Allgower type III Pilon fractures. Methods From January 2014 to March 2015, data of 16 Pilon fractures was retrospectively analyzed. There were 11 males and 5 females, with an average age of 43.5 years old (range, 19-62 years old). 9 patients were fall injuries, 5 patients were traffic injuries and 2 patients suffered from spraining injury. All of the fractures were closed type III according to Ruedi-Allgower classification with posterior Pilon fragment involved. A modified posteromedial approach, exploring fracture between flexor digitorum longus and flexor hallucis longus tendon, was employed to reduce and fix the posteromedial fragment, and an anterior approach (anteromedial, anterior intermediate, or anterolateral incision) was employed to reduce and fix the fibular fracture, depressed and anterior fragment. Burwell-Charnley radiological evaluation system and American Orthopaedic Foot and Ankle Society (AOFAS) functional scoring system were used for radiological and functional assessment respectively. Results The average time from injury to operation was 14.3 days (range10 to 20 days). Operating time was 120-240 min with an average time of 187.4 min. Intraoperative blood loss was 150-300 ml with an average of 218 ml. All patients were followed up, and the average duration of follow-up was 16.1 months (range, 12-24 months). Fracture healing time was 12-24 weeks with an average of 16.7 weeks. 13 patients got anatomical reduction, and 3 good reduction, with an anatomical reduction rate of 81.3% (13/16). The average AOFAS scale was 88.6, with an excellent good rate of 87.5% (14/16). Skin infection occurred in 1 patient and incision edge necrosis in 1 patient, which healed through dressing and debridement treatment. Conclusion Combined modified posteromedial and anterolateral approaches is a safe and effective method for the treatment of Ruedi-Allgower type III Pilon fractures, which can be recommended in clinical practice. Key words: Tibial fractures; Fracture fixation, internal; Treatment outcome