The Clinical Research Of The Surgical Treatment Of Tibial Pilon Fractures

Objective:Pilon fracture refers to distal tibia fractures which involve tibia-astragalus articularsurface. Its more complex injury mechanism, It is a highly unstable fracture, and havesevere articular cartilage damage, fracture and soft tissue injury often heavier, and thedistal tibial soft tissue weak, poor blood supply. Treatment is difficult, with manycomplications, prognosis not certain, high disability rate, and it is one of the mostchallenging orthopedic problems. The present study was performed to analyze Pilonfracture efficacy of surgical treatment methods and provide a reference for clinicians.Methods：This retrospective study related to45patients with operation treatment and completefollow-up records suffered tibial fractures from January2009to May2013.There were33cases male and12cases female aging from18to76(mean41.7±16.0).22cases of car accident injuries,11cases of falling injury，8cases of heavy pressing trauma，4cases ofsprain. According to Müller AO classification, there were10cases of43-B3,7type-43-C1,13type43-C2,15type43-C3. Among45patients,6were opened fractures and39were closed,21cases were left,24cases were right，30cases merging fibula fracture ofthe the same side. The classification of soft tissue injury method based onTscherne-Gotzen, the closed fractures were5cases of0°,15cases of1°,17cases of3°,2cases of4°. opened fractures were2cases of1°,4cases of2°. Full assessment of thefracture and soft tissue damage in preoperative, then to choose a suitable opportunity ofsurgery and give the appropriate surgical treatment. Guide patients to do postoperativerehabilitation training，proactive step by step after ankle functional exercise.Results：After10to40months of follow-up, with an average18.8±8.9months. Evaluated by the Burwell-Chamley Pilon fracture reduction radiology score:42cases wereanatomize reduction,2were function reduction and1was bad, the excellent andgood rate was93.3%.1case of open Pilon fractures, which were treated by means of debridement, and covering VSD and healed well after the fresh granulation tissue formed with skin flap transplantation.2cases of closed fracture had a skin necrosis and healed after strengthening dressing.1case delayed union.2patients with ankle joint stiffness, on account of postoperative functional exercise was not enough hand poor adherence. According to the Mazur Scale for ankle function,23cases were excellent (average95.5±1.8points),16cases good (average88.0±0.9points),5cases moderate (average76.6±6.5points) and1case bad (average62.0points), the rate of excellent and good was86.7%. There were no deep infection，fracture nonunion.Conclusions：According to the types of Pilon fracture and soft tissue damage at preoperative.Combined with the condition of the patient’s, then choose a suitable time for applicationand flexible fixation, with the individual treatment plan, can restore the function of the ankle joint, reduce the complications, and achieve a good clinical effects, improve the lifequality of the patient.