Comparative Analysis Of Clinical Efficacy Of Two Surgical Approachs Treatment Of Posterior Pilon Fractures

Objectives Compare the differences of function of ankle joint and complications pretherapy and post-treatment.Discuss the clinical effects of posterior Pilon fracture through postmedial approach or posterolateral approach.To provide reference opinions for the treatment of posterior Pilon fracture.Methods Collect the clinical case data of posterior Pilon fractures admitted by Affiliated Hospital of North China University of science and Technology(The second hospital of Tangshan)from October 2010 to October 2015,and choose 77 cases which treating the posterior Pilon fractures by using postmedial approach or posterolateral approach through strict inclusion and exclusion criteria.Collect and record the general data,imaging data,operation data,and carry on a retrospective statistical analysis.The whole 77 cases are divided into group A(postmedial approach)and group B(posterolateral approach)according to the different operative approach.Group A has 41 cases,involving 21 cases of male and 20 cases of female with age from 25 to 56(averagely 42.52±7.06 years)years.19 cases are left and 22 cases are right.23 cases were injured because of fall,18 cases because of sport injury.Group B has 36 cases,involving 19 cases of male and 17 cases of female with age from 26 to 57(averagely 41.14±8.17 years)years.17 cases are left and 19 cases are right.19 cases were injured because of fall,17 cases because of sport injury.About the fracture types,in group A there are 22 cases of posterior malleolus fracture with a single bone block and 19 cases of posterior malleolus fracture with two bone blocks,and 8 cases with compression fracture,and in group B there are 20 cases of posterior malleolus fracture with a single bone block and 16 cases of posterior malleolus fracture with two bone blocks,and 6 cases with compression fracture.The comparations between this two groups about gender,age,left or right,type of posterior malleolus fracture,injury mechanism,time of pre-operation are no statistical significance,P>0.05,are comparable(table 1).Record the length of the surgical incision,operation time,bleeding volume during the operation,the fracture healing time,and postoperative ankle joint function of these two group,and process the recorded data with statistical software SPSS19.0,to compare the general effect of the two different operative approaches in treating the posterior Pilon fractures.Results 77 patients received a 12~25 months long's follow-up,no patients had complications such as nonunion,vascular injury and internal fixation broken after operation.1 patient turned up superficial wound infection in group A,was cured after non-surgical treatment.1 patient felt his dorsolateral foot skin numbed in group B,this symptom was partly remitted after nourishing nerve treatment.And 1 patient turned up ankle pain,was diagnosed traumatic arthritis.In the posterior malleolus fracture with asingle bone block,comparing the length of the surgical incision,operation time,bleeding volume,fracture healing time,postoperative ankle joint function and excellent rate of the two groups,we can find the differences have no statistical significance(P > 0.05).In the posterior malleolus fracture with two bone blocks,the comparsion of difference of fracture healing time between group A and B has no statistical significance(P > 0.05),but comparing the length of the surgical incision,operation time,bleeding volume,postoperative ankle joint function and excellent rate of the two group,the differences have statistical significance(P(27)0.05).Conclusions Postmedial approach and posterolateral approach are both effective operative approach for treating the posterior Pilon fracture.When the posterior malleolus of the posterior Pilon fracture has a single bone block,the two kinds of operative approach are both effective,and the clinical effects of these two operative approaches are close.When the posterior malleolus of the posterior Pilon fracture has two bone blocks,the clinical effects of the postmedial approach is better than the posterolateral approach,thus the postmedial approach is the first choice.