Analysis Of The Efficacy Of External Fixator And Traction Of Calcaneus In The Treatment Of Severe Pilon Fractures At The First Stage

Objective:Compare the effect of the traction of calcaneus and external fixator in the early treatment of severe Pilon fracture, to provide the basis for the treatment of Ruedi- Allgower type Ⅲ tibial Pilon fractures at the first stage.Methods:From January 2011 to December 2015, 44 patients with severe Pilon fracture in the First Hospital of Jilin University were reviewed and analyzed.Patients were devided into two groups according to the treatment at the first stage. There were 24 cases in traction of calcaneus group,9 women, 15 men,with an average of 41.3 years old. There were 20 cases in external fixator group,6 women, 14 men, with an average of 42.3 years old. Soft tissue condition improved significantly through the supportive treatment at the first stage, after which the open reduction internal fixation were performed. The main outcome measures included age, height, weight, the time space between two stage surgery, VAS scores at 24 h, 3d, 7d after surgery, the operative time of second operation, the intraoperative blood loss in the second operation, the morbidity of complications, surgery cost, Mazur scores of ankle. For statistical analysis, spass 22.0 were used.Result:All patients have been followed up successfully and the mean follow-up was 24.3 months(3months-36months). The traction of calcaneus group, the average time space:(12.5±0.9)day; the operation time of second stage:(131± 15.1)minute; the intraoperative blood loss in the second stage(361.4 ±30.1)ml; the incidence of complications:29%; The external fixator group:(9.7± 1.1)days,the operation time of second stage:(112 ± 20.2)minute; the intraoperative blood loss in the second stage:(255.7±28)ml the incidence of complications:5%. The external fixator group was better than the traction of calcaneus group in these aspects. But the surgery cost of the external fixator group(70567.8 ± 3023.8yuan)is higher than the traction of calcaneus group(62576.4 ± 2526.0yuan). There were statistically significant(P<0.05)differences in these aspects. The VAS scores for external fixator group was significantly different from the calcaneus traction group, the former is much better(P <0.05).The Mazur scores of the two group had no significant statistically differences.Conclusion:For severe Pilon fracture( Ruedi-Allgower Ⅲ type), the early application of external fixation can effectively shorten swelling time, reduce soft tissue complications, alleviate the perioperative pain of patients, and can simplify second stage surgery.