EFFECTIVENESS OF VERY LOW PROFILE/VARIABLE ANGLE LOCKING PLATE INTERNAL FIXATION IN TREATMENT OF POSTERIOR Pilon FRACTURES EXTENDING TO MEDIAL MALLEOLUS BY POSTEROMEDIAL APPROACH_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WEIShijun ,  CAIXianhua , LIUXiming , WUGang , ZHANGZhiwen , CHENJia

Department of Orthopedics, Orthopedic Trauma Center of Chinese PLA, Wuhan General Hospital of Guangzhou Military Command, Wuhan Hubei, 430070, P. R. China;

Corresponding author：

CAIXianhua, Email: wgcaixh@163.com

Keywords：

Posterior Pilon fracture; Posteromedial approach; Very low profile/variable angle locking plate; Internal fixation

DOI：

10.7507/1002-1892.20140125

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Objective To evaluate the effectiveness of very low profile/variable angle locking plate (VLP) internal fixation for posterior Pilon fractures extending to the medial malleolus by posteromedial approach. Methods A retrospective analysis was made on the clinical data from 13 patients with posterior Pilon fractures extending to the medial malleolus between December 2011 and August 2012. There were 4 males and 9 females with an average age of 48.9 years (range, 23-68 years). Fractures were caused by falling in 9 cases and by traffic accident in 4 cases. The locations were the left ankle in 6 cases and the right ankle in 7 cases. According to the Orthopedic Trauma Association (OTA) classification, 6 cases were rated as type 43B1, 4 cases as type 43B2, and 3 cases as type 43B3. Twelve cases had fibular fractures, including 11 cases of Denis-Weber type B, 1 case of Denis-Weber type C. The interval of injury and operation was 7-14 days (mean, 11.4 days). Open reduction was performed and VLP internal fixation was used for posterior malleolar fracture by posteromedial approach. Results Primary healing of incision was obtained in all patients. Tibial nerve palsy was observed in 2 cases, and was cured after oral administration of mecobalamin. Twelve cases were followed up 12-18 months (mean, 14.5 months). According to the Burwell-Charnley's radiological evaluation system, 11 cases achieved anatomical reduction, 1 case achieved fair reduction. The fracture union time was 3-6 months (mean, 3.7 months). No loosening or breakage of internal fixation occurred during follow-up. According to the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, the results were excellent in 7 cases, good in 4, and fair in 1; the excellent and good rate was 91.7%. Conclusion VLP internal fixation for posterior Pilon fractures extending to the medial malleolus by posteromedial approach can achieve good short-term effectiveness. The high quality of reduction is acquired under direct vision with low rate of soft tissue complications.

Citation： WEIShijun, CAIXianhua, LIUXiming, WUGang, ZHANGZhiwen, CHENJia. EFFECTIVENESS OF VERY LOW PROFILE/VARIABLE ANGLE LOCKING PLATE INTERNAL FIXATION IN TREATMENT OF POSTERIOR Pilon FRACTURES EXTENDING TO MEDIAL MALLEOLUS BY POSTEROMEDIAL APPROACH. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(5): 558-561. doi: 10.7507/1002-1892.20140125 Copy

1.	俞光荣, 赵宏谋, 杨云峰, 等. 切开复位内固定治疗后踝骨折的疗效分析. 中国修复重建外科杂志, 2011, 25(7):774-777.
2.	Klammer G, Kadakia AR, Joos DA, et al. Posterior pilon fractures:a retrospective case series and proposed classification system. Foot Ankle Int, 2013, 34(2):189-199.
3.	樊健, 俞光荣, 周家钤, 等. 后外侧入路在老年性踝关节骨折中的应用. 中国矫形外科杂志, 2012, 20(10):865-867.
4.	Abdelgawad AA, Kadous A, Kanlic E. Posterolateral approach for treatment of posterior malleolus fracture of the ankle. J Foot Ankle Surg, 2011, 50(5):607-611.
5.	Amorosa LF, Brown GD, Greisberg J. A surgical approach to posterior pilon fractures. J Orthop Trauma, 2010, 24(3):188-193.
6.	Haraguchi N, Hiroki H, Hidekazu T, et al. Pathoanatomy of posterior malleolar fractures of the ankle. J Bone Joint Surg (Am), 2006, 88(5):1085-1092.
7.	William M, Murphy, Dieter Leu. Fracture classification//Ruedi TP, Murphy WM. AO principles of fracture management. New York:Thleme, 2000:45-53.
8.	Burwell HN, Charnley AD. The treatment of displaced fractures at the ankle by rigid internal fixation and early joint movement. J Bone Joint Surg (Br), 1965, 47(4):634-660.
9.	Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 1994, 15(7):349-353.
10.	Konrath GA, Hopkins G 2nd. Posterolateral approach for tibial pilon fractures:a report of two cases. J Orthop Trauma, 1999, 13(8):586-589.
11.	Liporace FA, Yoon RS. Decisions and staging leading to definitive open management of pilon fractures:where have we come from and where are we now? J Orthop Trauma, 2012, 26(8):488-498.
12.	Forberger J, Sabandal PV, Dietrich M, et al. Posterolateral approach to the displaced posterior malleolus:functional outcome and local morbidity. Foot Ankle Int, 2009, 30(4):309-314.
13.	Bhattacharyya T, Crichlow R, Gobezie R, et al. Complications associated with the posterolateral approach for pilon fractures. J Orthop Trauma, 2006, 20(2):104-107.
14.	李永舵, 刘书茂, 贾金生, 等. 后踝骨折内固定方法的选择:生物力学及临床应用研究. 北京大学学报:医学版, 2011, 43(5):718-723.
15.	胡海清, 张松, 金捷, 等. 经后侧入路支撑钢板内固定治疗后Pilon骨折的疗效观察. 中国骨与关节损伤杂志, 2012, 29(8):695-697.
16.	Borens O, Kloen P, Richmond J, et al. Minimally invasive treatment of pilon fractures with a low profile plate:preliminary results in 17 cases. Arch Orthop Trauma Surg, 2009, 129(5):649-659.

1. 俞光荣, 赵宏谋, 杨云峰, 等. 切开复位内固定治疗后踝骨折的疗效分析. 中国修复重建外科杂志, 2011, 25(7):774-777.
2. Klammer G, Kadakia AR, Joos DA, et al. Posterior pilon fractures:a retrospective case series and proposed classification system. Foot Ankle Int, 2013, 34(2):189-199.
3. 樊健, 俞光荣, 周家钤, 等. 后外侧入路在老年性踝关节骨折中的应用. 中国矫形外科杂志, 2012, 20(10):865-867.
4. Abdelgawad AA, Kadous A, Kanlic E. Posterolateral approach for treatment of posterior malleolus fracture of the ankle. J Foot Ankle Surg, 2011, 50(5):607-611.
5. Amorosa LF, Brown GD, Greisberg J. A surgical approach to posterior pilon fractures. J Orthop Trauma, 2010, 24(3):188-193.
6. Haraguchi N, Hiroki H, Hidekazu T, et al. Pathoanatomy of posterior malleolar fractures of the ankle. J Bone Joint Surg (Am), 2006, 88(5):1085-1092.
7. William M, Murphy, Dieter Leu. Fracture classification//Ruedi TP, Murphy WM. AO principles of fracture management. New York:Thleme, 2000:45-53.
8. Burwell HN, Charnley AD. The treatment of displaced fractures at the ankle by rigid internal fixation and early joint movement. J Bone Joint Surg (Br), 1965, 47(4):634-660.
9. Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 1994, 15(7):349-353.
10. Konrath GA, Hopkins G 2nd. Posterolateral approach for tibial pilon fractures:a report of two cases. J Orthop Trauma, 1999, 13(8):586-589.
11. Liporace FA, Yoon RS. Decisions and staging leading to definitive open management of pilon fractures:where have we come from and where are we now? J Orthop Trauma, 2012, 26(8):488-498.
12. Forberger J, Sabandal PV, Dietrich M, et al. Posterolateral approach to the displaced posterior malleolus:functional outcome and local morbidity. Foot Ankle Int, 2009, 30(4):309-314.
13. Bhattacharyya T, Crichlow R, Gobezie R, et al. Complications associated with the posterolateral approach for pilon fractures. J Orthop Trauma, 2006, 20(2):104-107.
14. 李永舵, 刘书茂, 贾金生, 等. 后踝骨折内固定方法的选择:生物力学及临床应用研究. 北京大学学报:医学版, 2011, 43(5):718-723.
15. 胡海清, 张松, 金捷, 等. 经后侧入路支撑钢板内固定治疗后Pilon骨折的疗效观察. 中国骨与关节损伤杂志, 2012, 29(8):695-697.
16. Borens O, Kloen P, Richmond J, et al. Minimally invasive treatment of pilon fractures with a low profile plate:preliminary results in 17 cases. Arch Orthop Trauma Surg, 2009, 129(5):649-659.

Chinese Journal of Reparative and Reconstructive Surgery

EFFECTIVENESS OF VERY LOW PROFILE/VARIABLE ANGLE LOCKING PLATE INTERNAL FIXATION IN TREATMENT OF POSTERIOR Pilon FRACTURES EXTENDING TO MEDIAL MALLEOLUS BY POSTEROMEDIAL APPROACH

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