The Clinical Research Of The Management Of High-energy Tibial Pilon Fractures

Objective: Pilon fractures are fractures of the distal metaphysis of the tibia involving the weight-bearing surface of the joint,a common intra-articular tibial fracture. and its more complex injury mechanism, fracture and soft tissue injury often heavier, and the distal tibial poor blood supply, soft tissue weak, and complications, and prognosis is not certain that bone disease is a problem. In this study,Analysis of curative effects of high-energy tibial pilon fractures with three kinds of surgical methods and put forward the best treatment method.Methods: From January 2003 to January 2009,33 patients with anti-record suffered high-energy tibial fractures (Rüedi type II or III)were divided three groups according to the fixation methods: 18 cases of male and 15 females, age 13, a 74-year-old, average 37.8 years old. 20 cases of car accident injuries, 13 cases of falling injury. According to Rüedi typing typing system,Ⅱ-type 16 cases,Ⅲ17 cases of type. for the treatment of 15 cases of Group A, 15 patients in group A were treated with over-articular external fixator combined with limited internal fixation, 10 patients in group B were treated with anatomic fracture plate(AFP) internal fixation, 8 patients in group C were treated with locking compression plate(LCP) internal fixation. 21 cases of open fractures, 12 cases of closed fracture. 15 cases of open fractures in the emergency shall be limited fracture debridement and internal fixation combined with over-articular external fixator fixation, six cases of emergency debridement calcaneal traction ,10-18 days, an average of 12.8 days after the second phase of open reduction and internal fracture fixation, 12 cases of closed fracture in the 7-14 days after injury, with an average 9.2 days after the two firms open reduction and internal fixation of fracture surgery. All patients with intra-articular distal tibial fractures were treated by the senior surgeon. Proactive step by step after ankle passive functional exercise.Results: After 3 months to 6 years of follow-up, patients with healed fractures. However, in the three kinds of treatment on clinical efficacy and complications are significant differences. The best effect to C group. Developed by Mazur and other symptoms and ankle function scoring system to assess the quality of its clinical efficacy rate was 87.5%, complication rate was37.5%.Conclusions: Pilon fracture under the high-energy fractures and soft tissue crushing conditions of the difference between surgery and choice of different fixation methods, a variety of treatment methods has its advantages and disadvantages, and indications. However, two-stage delayed open reduction and internal fixation locking compression plate can be an early resumption of the treatment group ankle function, a significant reduction in wound complications and nonunion, delayed union and so on, the treatment of high-energy fractures can be satisfied with the results, should be regarded as the treatment of high-energy fractures of the preferred method.