The Comparison Of Effect Of Two Different Methods For Treatment Of Severe Pilon Fracture

Objective The study, By analyzing the curative effects of limited internal fixationcombined with external fixation and delayed open reduction and internal fixationmethods on severe pilon fractures, aims at providing clinical evidence for choosingtreatment.Methods Taking the following42cases of severe pilon fractures that Dalian MedicalUniversity had treated,from September2007to January2012, by limited internalfixation combined with external fixation or delayed open reduction and internal fixation,30of whom were male patients, and12, female patients;14of whom with left legsinjured,28with right legs injured; Ranging from24to58years old;With20cases oftraffic injury,14of falling injury,5of tripping fall and3injured by crashing.Classifying the cases according to Rüedi-Allgower Classification：TypeⅡ:26cases,Type Ⅲ16；Open fractures:28, soft tissue damage by Gustilo dividing standard:TypeⅡ,20，Type Ⅲ,8.They were divided into two groups according to the differentways they were operated on. Group A, treated by the means of limited internal fixationcombined with external fixation, Debridement and limited internal fixation combinedwith external fixator of fracture fixation were given to open fractures. Closed fracture ofemergency was given limited internal fixation combined with external fixator offracture fixation. Group B given delayed open reduction and internal fixation, itincluding15cases of open fractures,7cases of closed fractures; Debridement was doneto the open fractures and steel plate internal fixation was provided to the fibula fracturefor the first phase, Then all the fractures were temporarily fixed by calcaneal traction orexternal fixator, with postoperative limb elevation, mannitol, sodium aescinatedetumescence, functional exercise actively, close observation of the skin temperature,blood supply, such as feeling changes, timely application of antibiotics to prevent infection, and watch the osteofascial compartment syndrome occurred. When soft tissuecondition allowed (7-21days), standard open reduction and internal fixation were doneto distal tibial articular surface in second phase.Results All these42patients recovered and all of them were paid follow-up visits toduring the period10to24months, with an average of18months. According to themazur ankle evaluation grading system, the excellence rate of group A was50%, groupB with an excellence rate of81.8%was the better. The excellence rates of the twogroups was noticeably different on a statistic basis. In terms of postoperativecomplications and skin necrosis infection: Group A:7cases; Group B:2cases, Therewere significant differences between the two groups. And in terms of fracture Healing,delayed union or not: Group A:3cases; Group B:2cases, The difference was notobvious. As to stiff joints,6in Group A,1in Group B, There were significantdifferences between these two groups.Traumatic arthritis:7cases in group A,1case ingroup B, The results between the two groups were dramatically different. With regard tointraoperative blood loss and fractures healing time: group B was superior to group A.Hospital stay: group A was superior to group B.Conclusions To treat severe pilon fracture, delayed open reduction and internalfixation is an effective method of early treatment with soft tissue repair as priority,focused on debridement, anti-infection, and soft tissue fixation; Reliable fixationinternal fixation in the second phase, can provide for joints, early functional exerciseand the ultimate stability of the fracture healing. And correct guidance on postoperativerehabilitation training is the key to satisfactory curative effect.