[Clinical results of modified medial approach in the treatment of Pilon fracture with medial column compression].

Objective: To explore the clinical results of modified medial incision in the treatment o f Pilon fracture with medial column compression and evaluate its safety.

Methods: Thirty-one patients of Pilon fracture with medial column compressiom accepted surgical treatments in the Department of Foot and Ankle at Honghui Hospital of Xi'an Jiaotong University from January 2015 to January 2019. According to the imaging data at admission, 31 cases were diagnosed as closed Pilon fractures, and both preoperative X-ray and 3D CT scan were shown as medial column compressive fractures. All patients underwent modified medial incision with complete data, including 23 males and 8 females;ranging in age from 22 to 65 years old, with an average of (39.5±16.2) years old. All patients underwent modified medial approach combined with other approaches to expose the broken end of fracture. The time from trauma to operation ranging from 7 to 20 days, with a mean of(9.5±5.5) days. The incision and fracture healing were followed up regularly after operation.

Results: All patients were followed up with an average of(15.7±5.5) months(ranged, 13 to 25 months). Preoperative and postoperative routine X-ray and 3D CT examination showed anatomical reduction in 8 cases, and the anatomical reduction rate was 25.81%. Up to the latest follow-up, all 31 fractures had achieved bone healing, and the healing time ranged from 11 to 22 weeks, with a mean of (14.3±4.7) weeks. At the latest follow-up, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot scores ranged from 75 to 89, with a mean of 80.5±4.9, 24 patients got a good result, 7 fair.

Conclusion: The improved medial approach for Pilon fracture can directly expose the posterior medial, medial and anterior medial of the distal tibia. After reduction under direct vision, the medial compressed and collapsed articular surface are fixed. The clinical curative effect is satisfactory and the wound complications are less. It is recommended for Pilon fracture where compression of the medial articular surface is predominant.