A Clinical Study Of Using The Anteromedial Fibula Approach In The Treatment Of Pilon Fracture

Background: Pilon fractures were an intra-articular fractures always combined with severe soft tissue injury.The clinical treatment was often challenge.When combined with fibula fracture,double incisions were preferred,but it may increase the soft tissue injury leading to a lot complications postoperation.It was important to select an appropriate surgical incision.This study was aimed to explore the outcomes of the treatment of 43-B and 43-C pilon fractures by an anteromedial fibula approach.Methods: Sixteen patients were included in our hospital from September 2015 to December 2017.Four cases were AO/OTA type 43-B and 12 cases were 43-C,including 15 males and 1 female with a mean age of 39.6 years(range: 20-60 years).All fractures were treated by ORIF through an anteromedial fibula approach when skin wrinkled.Postoperative,we evaluated the reduction of articular surface.The wound healing,fracture healing,AOFAS score,and the incidence of traumatic arthritis were recorded.Results: All patients were followed up for 9 to 24 months(average: 15.4 months).The incisions of fifteen case were healed in two weeks,1 cases had superficial infection and healed at 3 weeks.We used the Burwell-Charnley radiological criteria to evaluate reduction: anatomic reduction in 11 cases,satisfactory reduction in 4 cases,and 1 cases of poor reduction.The fractures were healed at a range of 12-18 weeks(average: 14.9 weeks).The AOFAS score ere an average of 87.1 points at 1 year after surgery.All patients achieved a satisfactory clinical outcome.Conclusions: Using an anteromedial fibula approach would give an effective visualization and fixation of tibia and fibula fractures together,with minimal soft tissue injury,a low incision infection rate,and few postoperative complications.It was a safe,simple,and effective approach that allows for satisfactory functional rehabilitation of the ankle joint.