ABSTRACT
Objective:
To compare the
therapeutic effects between sequential
therapy of external-internal fixation and internal fixation alone in the
treatment of high-energy pilon fracture.
Methods:
A total of 61
patients with high-energy pilon fracture were enrolled by our team for this retrospective
analysis who had been treated from January 2015 to July 2017. They received sequential
therapy of external-internal fixation (the sequential group) or internal fixation alone (the internal group). In the sequential group of 26 cases, there were 19
males and 7
females (
aged from 18 to 65 years), 4 cases of type C1, 8 cases of type C2 and 14 cases of type C3 by the OTA
classification, and 7 cases of closed
injury and 19 cases of open
injury. In the internal group of 35 cases, there were 25
males and 10
females (
aged from 19 to 64 years), 6 cases of type C1, 13 cases of type C2 and 16 cases of type C3 by the OTA
classification, and 21 cases of closed
injury and 14 cases of open
injury. The 2 groups were compared in terms of postoperative
infection,
fracture reduction, fracture union
time, nonunion, American Orthopedic
Foot and
Ankle Society (AOFAS)
ankle-hindfoot score, short form 36
health survey questionnaire (SF-36) and reduced
range of motion between healthy and affected
ankles.
Results:
There was no significant difference between the 2 groups in
gender, age, fracture type,
injury cause or follow-up
time ( P>0.05), but a significant difference in
soft tissue injury favoring the sequential group ( P=0.010). There were no significant differences between the 2 groups in postoperative
infection rate [15.4% (4/26) versus 17.1% (6/35)],
fracture reduction, fracture union
time [(7.4±3.4) months versus (6.5±3.2) months], nonunion rate [7.7% (2/26) versus 8.6% (3/35)], AOFAS
ankle-hindfoot score (71.7±29.4 versus 74.4±19.5), or SF-36 (83.1±9.9 versus 83.8±7.9) ( P>0.05). The reduced
range of motion between healthy and affected
ankles at 6 months postoperation in the sequential group (34.6°±7.2°) was significantly greater than that in the internal group (23.7°±5.1°) ( P<0.05), but there was no significant difference between the 2 groups in the reduced
range of motion between healthy and affected
ankles at 2 years postoperation (26.0°±11.1° versus 21.8°±11.3°) ( P>0.05).
Conclusion:
Although both sequential
therapy of external-internal fixation and internal fixation alone can
lead to fine
clinical efficacy in the
treatment of high-energy pilon fracture, the former may be more suitable for the
patients with severe
soft tissue injury.