[Fibular osteotomy and distal tibiofibular joint fusion for treatment of chronic valgus Pilon fracture malunion].

OBJECTIVE

To explore clinical effects of fibular osteotomy and distal tibiofibular joint fusion for chronic valgus Pilon fracture malunion.

METHODS

From January 2014 to January 2017, 8 patients with chronic valgus Pilon fracture malunion were treated, including 7 males and 1 female, aged from 20 to 47 years old, 6 patients on the left side and 2 patients on the right side; according to Rüedi-Allgöwer classification, 1 case was typeⅠ, 3 cases were typeⅡand 4 cases were type Ⅲ; the time from injury to admission ranged from 7 to 21 months. All deformities were evaluated individually based on pre-operatively weight bearing X-ray and 3D CT scan, and 3D printing model was also used for preliminary surgery. Weight-bearing X-ray showed posterior subluxation of ankle joint in 5 cases. There were 5 cases of fibular fracture at primary injury, and 2 cases of fibular fracture malunion. Fibular osteotomy and distal tibiofibular syndesmosis fusion strategy was performed to reduce articular surface congruency and correct lower limb alignment. Postoperative complication, fracture healing time and reduction were regularly recorded. Clinical function was evaluated according to American Orthopedic Foot and Ankle Society (AOFAS) at 1 year after operation.

RESULTS

All patients were followed up from 12 to 30 months. All incisions were primarily healed. No infection, neurovascular injuries or implant failure, lost of reduction occurred. Fracture healing time ranged from 13 to 19 weeks with good lower limb alignment. AOFAS score at 1 year after operation was 63 to 90 points, 1 patient got excellent result, 4 good and 3 fair. Seven patients returned to work at 6 to 14 months after opertaion.

CONCLUSION

For chronic valgus Pilon fractures malunion, fibular osteotomy and distal tibiofibular syndesmosis fusion could effectively restore congruency and alignment, correct lower limb alignment, improve ankle joint function, reduce occurrence of complication, and receive short term clinical effects.