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. In addition, the posterior fracture fragment of the tibia may be fully exposed through the fibula fracture gap by retraction. In conclusion, the posterolateral approach is able to achieve anatomical exposure of the operative field. 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). Anatomical reduction was confirmed in 17 patients, and an acceptable reduction was reported in 6 patients. The reduction in post-operative fractures was evaluated by determining the Burwell-Charnley scores at the last follow-up. The surgical procedure, reduction of post-operative fracture, peri-operative complications and post-operative functional recovery were reviewed and analyzed. Klammer's classification system was used to divide the posterior pilon fractures into 3 types. 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. However, methods for minimizing the associated surgical trauma and achieve effective fixation still require to be established. The treatment of this fracture pattern has been increasingly reported. It is important to use blunt dissection and the appropriate soft-tissue protection sleeves during pin placement.Posterior pilon fracture is a common type of intraarticular fracture encountered in clinical practice. The proximal pin should be placed in the anterior half of the tibia. Note: The course of the anterior compartment neurovascular bundle, and also the superficial peroneal nerve, should be considered during pin placement. The threaded rod of the distractor is placed posterolaterally, away from the incision. The distal pin, anterior to the axis of rotation of the talus, produces ankle joint distraction and plantarflexion, maximizing articular visualization. A second 4 mm Schanz pin is placed from lateral to medial into the tibial shaft, proximal to the intended plate. To apply the distractor laterally, a 4 mm Schanz pin is placed transversely from lateral to medial into the talar neck, through the surgical incision. A temporary joint bridging external fixator is typically replaced with a distractor during definitive articular surface reduction and fixation. Return of skin wrinkles is a good sign of soft-tissue recovery.Īpplication of a distractor intraoperatively greatly assists with articular visualization and alignment of several of the major articular fragments.
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