Modified posteromedial approach combined with anterolateral approach for treatment of posterior pilon fracture in supine position / 中华创伤骨科杂志

ABSTRACT

Objective:To investigate the clinical effects of the modified posteromedial approach combined with the anterolateral approach in the treatment of posterior pilon fractures in the supine position.Methods:A retrospective was conducted to analyze the clinical data of 54 patients [45 males and 9 females with an age of (47.7 ± 13.1) years] who had been treated surgically for posterior pilon fractures from January 2016 to December 2020 at Department of Orthopedics, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. The patients were divided into 2 groups according to their surgical positions: a supine group of 24 patients (the modified posteromedial approach combined with the anterolateral approach in the supine position) and a prone group of 30 patients (the posteromedial approach combined with the anterolateral approach in the prone position). The 2 groups were compared in terms of operation time, hospitalization time, radiographic outcomes (bone union time and ratio of congruent articular reduction), range of ankle motion, and postoperative complications. The post-operative function was evaluated using the Manchester Oxford Foot Questionnaire (MOXFQ) and the visual analogue scale (VAS).Results:There was no statistically significant difference between the 2 groups in the general clinical data before operation, showing comparability ( P>0.05). The mean follow-up time was (19.4 ± 4.4) months for the supine group and (17.8 ± 4.2) months for the prone group. The operation time, hospitalization time, bone union time, rate of fixation of syndesmosis and ratio of congruent articular reduction were (90.8 ± 9.9) min, (9.5 ± 2.4) d, (8.4 ± 1.4) weeks, 33.3% (8/24) and 95.8% (23/24) in the supine group, and (89.1 ± 10.8) min, (9.5 ± 2.5) d, (8.1 ± 1.4) weeks, 53.3% (16/30) and 96.6% (29/30) in the prone group, showing no significant differences (all P>0.05). At the last follow-up, the dorsiflexion and plantar flexion of the ankle, VAS, and MOXFQ scores for pain, walking and social capability were, respectively, 15.0° ± 2.1°, 26.1° ± 4.2°, (1.0 ± 0.5) points, 20.0(0, 30.0) points, (16.5 ± 13.2) points and 12.5(0, 18.8) points in the supine group, and 15.7° ± 1.6°, 27° ± 4.0°, (1.3 ± 0.7) points, 12.5(10.0, 30.0) points, (19.0 ± 11.5) points and 15.6(6.3, 25.0) points in the prone group, showing no significant differences ( P>0.05). The total incidence of complications was 8.3% (2/24) in the supine group and 3.3% (1/30) in the prone group, showing no significant difference either ( P>0.05). Conclusion:In the treatment of posterior pilon fractures, as the modified posteromedial approach combined with the anterolateral approach in the supine position is equivalent to the posteromedial and the posterolateral approaches in the prone position in terms of reduction quality, bone union time, functional outcomes and complications, it can be used as an alternative choice.