The Comparative Analysis Of Different Surgical Fixation Methods Of AO Type C3Pilon Fractures

Objective AO type C3Pilon fractures is the most complex fractures trauma oflower limb, its treatment until now is still one of the challenging topics traumatic oforthopedic surgeons. There are a variety of treatments, but the large difference ofcurative effect is reported. By our college in recent years clinical AO type C3Pilonfractures with three kinds of surgical curative effect observation of fixed way, byanalyzing the advantages and disadvantages of three kinds of operation method, toprovide further guidance for future clinical work.MethodsWe retrospectively reviewed the clinical records of42patients with AO type C3Pilon fractures for three kinds of different treatment: anatomic fracture plate(AFP)group (10cases),minimally invasive locking plate fixation(MIPPO) group(14cases),limited ORIF with external fixation group(18cases), all these patients were followedup for6to48months with an average of24months. We examined clinically andradiologically during the follow-up period，compared and analysed the three kinds ofdifferent treatment methods from the average hospitals stays, pain, swelling, the rateof infection and posttraumatic arthritis, the range of motion of the ankle. Burwell–Charnley’s radiographic criteria of reduction are used for fracture reconstructionquality, and Mazur’s ankle evaluation grading system are used for evaluate theclinical outcomes.ResultsAccording to the Mazur’s ankle evaluation grading system,17cases were excellent,11cases were good,10cases were fair, and4cases were poor, the excellentand good rate was66.1%,the excellent and good rate of the AFP group was58.1%,MIPPO group was74.2%, limited ORIF with external fixation group was66.7%,There was no statistically significant difference between three groups. The imagingresults press Burwell–Charnley’s evaluation criterion for fracture reconstructionquality,17cases were anatomical reduction,20cases were functional restoration,5cases were unsatisfactory reduction, the excellent and good rate of the AFP group was90.0%, MIPPO group was92.8%, limited ORIF with external fixation group was83.3%,. There was no statistically significant difference between three groups.Compare the average length of hospital stay,18.32days for AFP group,16.25days forMIPPO group, and17.25days for limited ORIF with external fixation group, Therewas no significant difference between three groups. The incidence of postoperativeand anaphase complications were40%and30%for the AFP group,14.3%and21.4%for the MIPPO group, while16.7%and27.8%for the limited ORIF with externalfixation group. There were significant difference among the three groups in theincidence of postoperative, but no significant difference in the incidence of anaphasecomplications.ConclusionBy using MIPPO or limited ORIF with external fixation for AO type C3Pilonfractures, can reduce the damage to the skin soft tissue, reduce the risk ofpostoperative incision complications. especially in the case of large area skin and softtissue defect and infection, the limited ORIF with external fixation has certainadvantage; Strong internal fixation can increase the rate of good postoperative andreduce the incidence of traumatic osteoarthritis.