Analysis Of Clinical Effects Of Limited Open Reduction And Internal Fixation On Type Ⅱ And Type Ⅲ Pilon Fractures

Objective : To explore the clinical effect of limited open reduction and internal fixation for the treatment of type Ⅱ and Ⅲ Pilon fractures of the distal tibia.Methods:The clinical data of 28 patients with type Ⅱ and type Ⅲ Pilon fractures of distal tibia treated in our hospital from April 2015 to July 2019 were collected and retrospectively analyzed,including 15 males and 13 females,age range 18 to 70 years old,with an average of 46.6 years old.There were 15 cases on the left and 13 cases on the right.There were 19 cases of falling injuries from heights,3 cases of traffic accident injuries,5 cases of sprains,and 1 case of heavy objects.There were 24 cases of closed fractures and 4 cases of open fractures.According to the Rüedi-Allgower classification system,cases were classified into 17 cases of type Ⅱ and 11 cases of type Ⅲ.Open fractures were classified according to Gustilo system: 1 case of type Ⅰ and 3 cases of type Ⅱ.Among the open fracture cases,1 case of open fracture underwent one-stage open reduction and internal fixation,3 cases of open fracture underwent temporary fixation after emergency debridement and suture,and extended reduction and internal fixation was performed after 12-17 days;1 case of closed fractures received one-stage open reduction and internal fixation,and the remaining 23 cases underwent delayed open reduction and internal fixation.The operation time was 5 to 17 days after injury.Postoperative underwent systematic and standardized rehabilitation functional exercise.Mazur ankle function score was used to evaluate ankle function after operation,and Burwell-charnley standard was used for radiographic evaluation of Pilon fracture reduction after operation.Result : All 28 patients were followed up for 7 to 36 months,with an average of 18.8 months.According to Mazur ankle function evaluation: 13 cases were excellent,8 cases were good,6 cases were fair,1 case was poor,and the excellent and good rate was 75%.Radiological evaluation of postoperative reduction according to Burwell-charnley standard: 19 cases were anatomical reduction,8 cases were general reduction,and 1 case was poor reduction.Conclusions:The effect of limited open reduction and internal fixation on Pilon fractures of type Ⅱ and Ⅲ is satisfactory.Carefully evaluate the type of fracture and soft tissue of the patient before surgery,and choose the appropriate timing of the operation according to the patient’s own situation,develop a personalized surgical plan,fine operation during the surgery,strengthen the protection of soft tissue and follow the principle of "early activity,late weight bearing",systematic functional exercise can reduce the incidence of complications,restore ankle function as soon as possible,and improve the patient’s quality of life.