Treatment outcomes of the posterolateral approach of plate fixation for posterior pilon fractures

Abstract

Posterior pilon fracture is a common type of intraarticular fracture encountered in clinical practice. The treatment of this fracture pattern has been increasingly reported. However, methods for minimizing the associated surgical trauma and achieve effective fixation still require to be established. The present study involved 23 patients with posterior pilon fracture treated at the First Affiliated Hospital of Soochow University (Suzhou, China) between March 2013 and October 2017. Klammer's classification system was used to divide the posterior pilon fractures into 3 types. The surgical procedure, reduction of post-operative fracture, peri-operative complications and post-operative functional recovery were reviewed and analyzed. The reduction in post-operative fractures was evaluated by determining the Burwell-Charnley scores at the last follow-up. Anatomical reduction was confirmed in 17 patients, and an acceptable reduction was reported in 6 patients. The American Orthopedic Foot and Ankle Score was used to assess ankle function recovery; the average score was 82.3 points (range, 44-97 points). In conclusion, the posterolateral approach is able to achieve anatomical exposure of the operative field. In addition, the posterior fracture fragment of the tibia may be fully exposed through the fibula fracture gap by retraction. Posterior placement of the plate may serve a definitive role in the fixation of the posterior fracture fragment and maintain stability in the anatomical reduction of the fracture, which is helpful in early functional rehabilitation.

Posterior pilon fracture treated by opening the fibula fracture gap

“…The AOFAS score was significantly higher in the OFFL group than in the TPL group at the final followup (p = 0.037). Also using the traditional posterolateral approach, the anatomic repositioning rate was higher than the 53.8% of Klammer et al [2] and the 73.9% of Gao et al [11]. The AOFAS score was also higher than the 82 points of Klammer et al [2] and the 82.3 points of Gao et al [11].…”

“…Numerous surgical procedures are currently available to treat posterior pilon fractures, but posterior posterolateral is the most commonly used. This is because it allows one incision to fix the posterior and lateral ankle [2,[6][7][8][9][10][11]. The current surgical challenge is to adequately visualize the distal tibial fracture break and to deal with small bone fragments embedded in the fracture, such as die-punch bone fragments, cartilage pieces and soft tissue.…”

“…The current surgical challenge is to adequately visualize the distal tibial fracture break and to deal with small bone fragments embedded in the fracture, such as die-punch bone fragments, cartilage pieces and soft tissue. Therefore, the rate of anatomic resetting in previous studies was not too high [2,11]. Klammer uses an "open book fashion" technique to open the posterior fracture to reveal the tibial articular surface [2].…”

“…Our team believes that posterior pilon fractures involve the posterior articular surface of the distal tibia and that anatomic repositioning is mandatory. Currently, there are many surgical approaches for posterior pilon fractures, such as the posterolateral approach, the posterior-medial approach, or the modified posterior-medial approach [2,[6][7][8][9][10][11]. However, the best treatment for posterior pilon fracture is a matter of opinion.…”

Posterior Locking Plate Fixation of Bartoníček Type IV Posterior Malleolar Fracture: A Focus on Die-Punch Fragment Size

“…Others have used some of the same outcome measures to assess ankle function recovery after surgery for PMFs. For example, Gao et al reported on patients who underwent a posterolateral approach to reduction and plate fixation of posterior pilon fractures (19). They used the AOFAS score to assess ankle function recovery in 23 patients, and they found it to be 82.3 (range 44-97).…”