The Treatment Strategies Of Ruedi III Pilon Fractures

Pilon fracture is the distal tibia fracture involving the articular surface,the heavy energetic pilon fracture of tibial increased obviously With the rapid development of modern transportation and the construction industry,pilon fracture is usually caused by high-energy injury,the injury of soft tissue is also heavier,and the blood supply of distal tibial is very poor.These features determine the treatment of pilon fractures is very difficult,the incidence of post-operative complications and disability rate is very high,pilon fracture is the most challenging one of the orthopedic problems.There are many methods in the treatment of tibial pilon fractures.The methods can be generally divided into three ways:classic open reduction and internal fixation(ORIF),limited internal fixation combined with external fixation and two-stage delayed open reduction and internal fixation.The majority doctors reported the treatment effect of Ruediâ… -â…¡pilon fracture is good,but the result of Ruediâ…¢pilon fracture is Unsatisfactory.For the Ruediâ…¢pilon fracture,the treatment of classic open reduction and internal fixation often can not achieve a satisfactory surgical results,the doctors tend to use the methods of limited internal fixation combined with external fixation or two-stage delayed open reduction and internal fixation to treat Ruediâ…¢pilon fracture.However,there is no clear clinical study shows that which method can be a preferred way in the treatment of high-energy Ruediâ…¢pilon fracture.Objective:exploring the different surgical treatment and their application of Ruediâ…¢pilon fractures,finding out the best treatment.Method:We retrospectively reviewed the clinical records of 36 patients from January 2001 to October 2008 of the First Hospital of Jilin University. There are 27 male patients and 9 female patients,age from 12 to 68 years old, the mean age is 37.7 years old.Cause of injury:28 cases of traffic injury,8 cases of falling injury.There are 29 cases of closed fracture,7 cases of open fracture (Gustiloâ… type 3 cases,â…¡type 4 cases).The time from injury to operation is 2h to 14d,the average is 7 days.The methods can be divided into three groups according to different treatment ways.Group A:open reduction and internal fixation,18 cases;Group B:limited internal fixation combined with external fixation,9 cases;Group C:two-stage delayed open reduction and internal fixation 9 cases.Result:All patients were followed up for 6 to 76 months with an average of 35 months.There was no significant difference in the postoperative imaging of the three groups.The incidence of early complications:group A was 50%,group B and group C was 11.1%,there are significant statistical difference in the three groups;The incidence of late complications:group A was 27.8%,group B and group C was 22.2%,there are no significant statistical difference in the three groups.Assessing the ankle function with the Mazur criteria,38.9%of group A patients was rated good to excellent,while group B and group C was 66.6%, there are significant statistical difference in the three groups,group B and group C were better than group A.Conclusion:1.The classical open reduction and internal fixation(ORIF) is only applicable to Ruediâ… ,â…¡Pilon fractures which have a good soft tissue conditions and low-energy injury.It shoule be not used in the Ruediâ…¢Pilon fractures.2.The method of limited internal fixation combined with external fixation and two-stage delayed open reduction and internal fixation became popular ways in the treatment of Ruediâ…¢Pilon fractures.Compared with ORIF, the method of limited internal fixation combined with external fixation and two-stage delayed open reduction and internal fixation can achieve a better result in the incidence of early complication and the recovery of ankel function. 3.There are many ways in the treatment of pilon fractures at present,but to the Ruediâ…¢Pilon fractures,no one method shows more satisfactory clinical effects than others.It is necessary to further the development of new fixation materials and surgical method which can be in line with the ankle anatomy and biomechanics.Also we should increase the means of adjuvant therapy in order to find out the best option in the treatment of Pilon fractures.