[Redintegration of articular surface with tibia type III Pilon fracture].

Objective: To explore an improved method of surgical operation for reposition of the articular surface with Type III Pilon fractures.

Methods: From January 1999 to December 2005, 20 patients (22 sides) with Type III Pilon fractures were treated with the delayed open reduction and the internal fixation, which took the superior articular surface of the talus as a templet so as to reposition the lower articular surface of the tibia, strengthen the bone transplantation, fasten the internal fixation, and make an early functional exercise possible. Complete data were obtained from 16 of the patients with 18 sides (13 males, 15 sides; 3 females, 3 sides; age, 14-48 years). The injury due to a falling accident was found in 12 patients (14 sides), and due to a traffic accident in 4 patients (4 sides).

Results: The healing of the first intention was achieved in 14 sides, the delayed healing in 3 sides, and the infection in 1 side. The follow-up of all the 16 patients for 9-71 months (average, 22 months) including the X-ray examinations revealed that no screw for the internal fixation entering the articular cavity. According to the Teeny's judging standards of radiology evaluating the result of the surgery for Pilon fractures, the anatomical reduction of the related articular surface was found in 77.8% of the sides (14/18) and the healing of the first intention (stage I ) in 94.4% (17/18). According to the Mazur's criteria, an excellent result was obtained in 5 sides, good in 7, fair in 5, and poor in 1. The excellent and good result was 66.7%.

Conclusion: Proper management of the injured soft tissues, prompt recovery of the tibial distant plateau height, and accurate reposition of the articular surface, enough transplant bone for the solid support, strong internal fixation for the distant tibial anatomical structure, and early functional exercise are the key points to the successful operation.