[360 degrees INTERNAL FIXATION BY DOUBLE APPROACHES FOR HIGH-ENERGY CLOSED Pilon FRACTURES]

To observe the effectiveness of 360 degrees internal fixation by anteromedial and posterior-lateral approaches for high-energy closed Pilon fractures.

Between February 2013 and February 2015, 18 cases of high-energy closed Pilon fractures were treated. There were 11 males and 7 females with an average age of 40.5 years (range, 20-65 years). The causes were falling injury in 10 cases and traffic accident injury in 8 cases. All fractures were Rüedi-Allgower type III Pilon fracture combined with ipsilateral fibula fracture. The average interval from injury to operation was 8 days (range, 5-13 days). Reduction of fracture was performed by anteromedial and posterior-lateral approaches and the fracture fragments were fixed by 360 degrees internal fixation. The effectiveness was assessed by ankle X-ray film and Mazur score at last follow-up.

Two cases had skin necrosis and received flap surgery, the other cases obtained primary healing of incision. All the cases were followed up 11.2 months on average (range, 3-27 months). X-ray film showed that all fractures healed at 3-4 months after operation (mean, 3.6 months). No deep infection or plate exposure occurred. According to Mazur score, the results were excellent in 8 cases, good in 7 cases, fair in 2 cases, and poor in 1 case, and the excellent and good rate was 83.3%.

The effectiveness of the 360 degrees internal fixation for treatment of high-energy closed Pilon fractures has the advantages of reliable fixation, early functional exercise, and good functional recovery of the ankle joint.