Orthopaedic Department, General Hospital of Central Theater Command of PLA, #627 Wuluo Road, Wuchang District, Wuhan, 430070, China.
Clinical Medicine, Wuhan University of Science and Technology, #2, West Huangjiahu Road, Hongshan District, Wuhan, 430081, China.
J Orthop Surg Res. 2022 Apr 7;17(1):214. doi: 10.1186/s13018-022-03106-4.
Posterior pilon fracture is a relatively common clinical fracture involving the posterior articular surface of the distal tibia. Currently, this form of fracture is receiving increasing attention. The surgical approach and technique for the treatment of posterior pilon fractures are still controversial. The purpose of this retrospective study was to compare the clinical and imaging outcomes of pilon fractures after treatment with the open fibula fracture line (OFFL) surgical technique versus the traditional posterolateral approach (TPL).
A retrospective analysis of patients with posterior pilon fractures treated using the open fibula fracture line technique and the traditional posterolateral approach between January 2015 and March 2020. Thirty-one cases were included in the open fibula fracture line technique group and twenty-eight cases were included in the traditional posterolateral approach group. We used the Burwell-Charnley scale to assess the effectiveness of surgical repositioning. The clinical outcomes were evaluated using American Orthopaedic Foot & Ankle Society ankle-hind foot score (AOFAS) and visual analog score (VAS).
The overall anatomic reduction rate was slightly better in the open fibula fracture line group than in the conventional posterolateral group (81% vs. 71%, p = 0.406), but there was no statistically significant difference between the two groups. There were no statistically significant differences between the two groups in terms of fracture healing time and time to full weight bearing (p > 0.05). At the final follow-up, the AOFAS functional score of the open fibula fracture line group was statistically superior to that of the conventional posterolateral group (p < 0.05). However, there was no statistical difference between the two groups in VAS pain scores at rest, during activity, and under weight bearing (p > 0.05).
The trans-fibular fracture approach provides a better surgical option for specific types of posterior pilon fractures with a high rate of anatomic repositioning and a good near-term outcome.
Retrospective registration.
后踝骨折是一种较为常见的临床骨折，涉及胫骨远端后关节面。目前，这种类型的骨折越来越受到关注。对于后踝骨折的治疗，手术入路和技术仍存在争议。本回顾性研究的目的是比较经腓骨骨折线入路（OFFL）与传统后外侧入路（TPL）治疗后踝骨折的临床和影像学结果。
回顾性分析 2015 年 1 月至 2020 年 3 月采用经腓骨骨折线技术和传统后外侧入路治疗的后踝骨折患者。OFFL 组 31 例，TPL 组 28 例。采用 Burwell-Charnley 评分评估手术复位效果。采用美国矫形足踝协会踝后足评分（AOFAS）和视觉模拟评分（VAS）评估临床疗效。
OFFL 组总体解剖复位率略优于 TPL 组（81%比 71%，p=0.406），但差异无统计学意义。两组骨折愈合时间和完全负重时间差异无统计学意义（p>0.05）。末次随访时，OFFL 组 AOFAS 功能评分明显优于 TPL 组（p<0.05）。但两组在休息、活动和负重时的 VAS 疼痛评分差异无统计学意义（p>0.05）。
经腓骨骨折线入路为特定类型的后踝骨折提供了更好的手术选择，其解剖复位率高，近期疗效好。
回顾性注册。
