[Choice of treatment for fracture of distal tibia with ankle joint involvement]

It is difficult to treat the intra-articular fracture of distal tibia or Pilion's fracture. From 1987 to 1995, 43 cases of Pilon's fracture were admitted and treated with different methods. After treatment, they had been followed up for 1 to 8 years. According to Riiedi's Classification, there were type I 12 cases, type II 21 cases and type III 10 cases. The methods used on these patients included manual reduction and plaster of paris immobilization, calcaneous tubercle traction and plaster of paris immobilization, open reduction and internal fixation with Kirschner wires, and open reduction and internal fixation with AO plate. The outcome was evaluated according to Ovadia's criteria, for type I fracture, 8 cases were treated with conservative method with a satisfactory rate of 79.17% and 4 cases were treated with operation with a satisfactory rate of 91.67%; for type II, conservative method for 12 cases and the satisfactory rate was 33.33%, and operation for 9 cases with a satisfactory rate of 70.37%; for type III, conservative method for 2 cases, with poor result, and operation for 8 cases with satisfactory rate of 79.17%. The indication for conservative treatment was type I fracture. It showed that for Pilon's fracture, the outcome of open reduction and internal fixation was superior to that of the conservative treatment, especially in those having internal fixation with AO plate.