Four Surgical Approach Of Pilon Fractures Treated By Minimally Invasive

Background:Pilon fracture is related to complex fractures of the distal tibial articular surfaces, this type of fracture is high energy more damage,Fracture displacement was very unstable, fragments, distal tibial thinner soft tissue, and therefore usually additional serious soft tissue injury,therefore is difficult to treat. The prognosis is not stable. Usually associated with different degree of soft tissue injury, the traditional open reduction and internal fixation can aggravate the injury of soft tissue.However, minimally invasive surgery has a of articular surface reduction and fixation difficult problems may lead to the damage of high energy Pilon fracture.Objective:Using a minimally invasive approach for surgical treatment of Pilon fracture, summarize four kinds of minimally invasive approach in the treatment of Pilon fractures respective adaptation disease,contraindication, operation time, operation effect, advantages and disadvantages of the, and other references in the traditional open reduction and internal fixation for the treatment of Pilon fracture surgery way and curative effect were compared for Pilon fracture treated by internal fixation surgery approach and future clinical studies provide reference.Methods:a retrospective study from January 2014 to January 2016 ilin university second affiliated hospital inpatient trauma surgery. Selected cases were unilateral Pilon fracture. Patients with severe skin and soft tissue injuries, two or more than two of the patients who underwent surgical treatment were treated with a single approach. data integrity, data is incomplete, follow-up interruption as not choose cases. Selected cases,a total of 36 cases, 26 patients with male and female patients with 10 cases, aged 20 to 62, the average age of 37 years old; Damage reason:high falling injury 21 cases, 12 cases traffic accident injury, sprain 3 cases,28 cases of fibula fracture; According to AO classification: B2 type 5cases, 7 cases of B3 type, C1 type 4 cases, 8 type C2 and C3 type 12cases; According to the surgical approach: group A: the medial approach before 6 cases, group B: 9 cases of anterolateral approach and group C: 9cases of medial approach and group D: 12 cases before the ankle area. All the fractures are fresh fractures, 7 cases of open fractures. All patients received one of the four approaches for treatment. All cases of postoperative follow-up, adopt the method of outpatient follow-up appointments on a regular basis, collected the clinical data and guide line in patients with functional exercise.Results :36 patients were followed up for 3 ~ 20 months, an average of 10 months. Line 7 patients with open Pilon fractures by debridement and(or)flap repair wounds are closed for good, neither deep infection of the wound, wound dehiscence, steel leakage, etc. Three patients with intraoperative sustained repeated pull, extrusion and soft tissue damage,skin mild fell out, the three patients after the treatment cured; Dorsalis pedis persistent numbness, 2 cases with phil shallow branch nerve injury,after symptomatic treatment of symptoms. The fracture of the Burwell-Charnley, radiological evaluation standard to evaluate, 36 patients postoperative tibial distal articular surface anatomical reduction and 32 cases, reset general 4 cases, poor reset 0 cases, not seen, translocation and internal fixation of fractures and loose phenomenon. Postoperative follow-up of X ray film in callus appeared time 4 ~ 12 weeks, 8 weeks,the average bone healing time 2 months to 7 months, an average of 3.8months. Ankle function using said Mazur ankle evaluation grading system to evaluate, 24 patients with ankle function optimal 21 cases, 11 cases, 4 cases, the total was 87.5%. Based on 36 cases of Pilon fractures in patients with postoperative follow-up, have not found the bone fracture nonunion, malunion, stiff joints, traumatic arthritis and late complications such as chronic osteomyelitis.Conclusion:Minimally invasive approach is an effective surgical procedure for the treatment of Pilon fractures. Compared with the traditional surgical approach, minimally invasive approach retains the complete blood circulation, avoids the extensive exposure of the fracture end and the destruction of the periosteum, and has the effect of restoration and the effect of the treatment. According to different cases of Pilon fractures, the above four kinds of minimally invasive approach can provide more "individual" approach selection. This study provides clinical reference for the first choice of operative approach and the future clinical study of Pilon fracture.