Minimally invasive single locking plate combined with multiple planar screw internal fixation for pilon fracture

Objective To investigate the clinical effect of minimally invasive single locking plate combined with multiplanar screw internal fixation on pilon fracture of distal tibia. Methods A retrospective case control study was conducted to analyze the clinical data of 51 patients with pilon fracture involving distal tibial articular surface admitted to 81th Group Military Hospital of the Army from January 2013 to August 2017. Among the patients, 20 patients including 15 males and five females, aged (37.5±9.9)years were treated with closed traction reduction or open joint reduction through minimally invasive incision and single main locking plate combined with multiplanar screw placement (study group). There were 13 patients with type II and seven patients with type III according to Ru edi-Allgwer classification of fracture. In addition, 31 patients were treated with open reduction and multi-plate internal fixation (control group), including 25 males and six females, aged (43.4±11.3) years. There were 20 patients with type II and 11 with type III according to Ru edi-Allgwer classification. The operation time, fracture healing time, postoperative complications were compared between the two groups. Burwell-Charnley imaging evaluation criteria were used to assess the quality of fracture reduction. At the last follow-up, ankle function was assessed by the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hind foot functional score. Results All 51 patients were followed up for 6-24 months, with an average of 16 months. The operation time was (82.5±19.2)minutes in the study group and (127.7±40.8)minutes in the control group (P 0.05). Local skin necrosis (not above the plate) occurred in two patients in the study group and in three patients in the control group, with the wounds being healed within 3 months after dressing change and vacuum sealing drainage (VSD). In the control group, one patient had severe infection and recovered after treatment of steel plate removal, debridement and irrigation, and external fixator fixation. Three patients in the control group had skin necrosis resulting in plate exposure, who received transferred skin flaps to cover the wound. The incidence of postoperative complications were 10% (2/20) and 23% in the study group and the control group, respectively (7/31)(P>0.05), with the incidence of severe complications for 0 and 13% (4/31)(P 0.05). At the last follow-up, AOFAS ankle-hind foot function scores were excellent in 12 patients, good in five patients, fair in two patients and poor in one patient in the study group with excellence rate of 85%, while the scores were excellent in 20 patients, good in six patients, fair in three patients and poor in two patients in the control group, with excellence rate of 84% (P>0.05). Conclusion For pilon fracture of distal tibia, both minimally invasive single locking plate combined with multi-plate screw internal fixation and open reduction combined with multi-plate internal fixation have good reduction effect and satisfactory recovery of ankle function, but the former can significantly shorten the operation time and reduce the incidence of serious complications after operation. Key words: Tibial fractures; Fracture fixation, internal; Pilon fractures