Modified posteromedial approach for treatment of posterior pilon variant fracture.

Yukai Wang,Cong Feng Luo,Jianwei Wang

doi:10.1186/s12891-016-1182-9

Yukai Wang, Cong Feng Luo + Show 1 more

Open Access

https://doi.org/10.1186/s12891-016-1182-9

Copy DOI

Abstract

BackgroundPosterior pilon variant fracture is a recently described posterior malleolus fracture characterized by the involvement of both posterolateral and posteromedial malleolar fragment. The associated surgical approach remains controversial. The aim of this study was to present the application of modified posteromedial approach in the treatment for posterior pilon variant fracture.MethodsSixteen patients were identified with posterior pilon variant fractures. All fractures were operated via modified posteromedial approach. Fragment length ratio, area ratio and height were measured as morphologic assessments. The clinical outcome was evaluated with American Orthopaedic Foot & Ankle Society ankle-hind foot score and visual analogue scale. Radiological images were evaluated using osteoarthritis-score.ResultsAccording to the radiological measurements, the average fragment length ratio of posteromedial and posterolateral fragment was 25.3 and 31.5 % respectively. All fractures healed within a mean period of 13.1 weeks without malalignment or articular step-off. Fourteen patients were followed up, and all achieved good or excellent ankle function. The average score of American Orthopaedic Foot & Ankle Society and visual analogue scale at rest, motion and weight bearing walking was 85.6 and 0.25, 0.81, 1.31 respectively.ConclusionModified posteromedial approach provides an alternative surgical treatment for posterior pilon variant fractures, and the short-term outcome was good.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-016-1182-9) contains supplementary material, which is available to authorized users.

Highlights

Posterior pilon variant fracture is a recently described posterior malleolus fracture characterized by the involvement of both posterolateral and posteromedial malleolar fragment
No consensus has been reached on the best way to approach posterior pilon variant, though posterolateral approach has been widely accepted in direct reduction and fixation of posterior malleolus [5, 6, 11, 15, 16]
In pathoanatomy studies focusing on posterior malleolar fractures [3, 4], those posterolateral (PL) fractures with transverse medial extension were classified as Haraguchi Type II, which has a 29.8 % involvement of tibial plafond area [4]

Summary

Introduction

Posterior pilon variant fracture is a recently described posterior malleolus fracture characterized by the involvement of both posterolateral and posteromedial malleolar fragment. Different from standard trimalleolar and Volkmann fracture, posterior malleolar fracture in ‘posterior pilon variant’ split into PM and PL fragment [3, 4, 8] To date, taking both fracture morphology and injury mechanism into consideration, “posterior pilon variant” as we adopted in this article, may indicate an independent fracture pattern, which requires special attention in surgical approach and appropriate fixation. Question remains what is the optimal solution to posterior pilon variant, as current evidence relevant with treatment is limited. We consider it necessary that anatomical reduction should be achieved regardless of the size of posterior tibial plafond fragment(s), as talar subluxation may persist without surgical management of PM fragment [2, 12]. No consensus has been reached on the best way to approach posterior pilon variant, though posterolateral approach has been widely accepted in direct reduction and fixation of posterior malleolus [5, 6, 11, 15, 16]

Objectives

Methods

Results

Discussion

Conclusion