[SURGICAL TREATMENT OF Rüedi-Allgöwer III Type Pilon FRACTURES].

OBJECTIVE: To study the surgical treatment method and effectiveness of Rüedi-Allgöwer III type Pilon fractures.

METHODS: Between May 2011 and April 2013, 25 cases of Rüedi-Allgöwer III type Pilon fracture (5 cases of open fractures and 20 cases of closed fractures) were treated. Of 25 cases, 16 were male, and 9 were female, aged 24-45 years (mean, 31 years). The left side was involved in 8 cases, and the right side in 17 cases. The disease causes were falling from height in 11 cases, traffic accident injury in 9 cases, and crash injury in 5 cases. The interval of injury and admission was 10-36 hours (mean, 23.5 hours). The open reduction and internal fixation by posterolateral fibular incision and exposure of distal tibia and tibiotalar articular surface by anterior ankle incision were performed; the tibiotalar articular surface was reset and the tibia fracture end was fixed.

RESULTS: Healing of incision by first intention was obtained in 15 cases, and healing by second intention in 6 cases undergoing skin grafting. Tension blister occurred in 4 patients, who achieved healing by second intention after treatment. All 25 patients were followed up 6-12 months (mean, 8 months). During follow-up, no complication of ankle joint instability, traumatic arthritis, or loosening and breakage of internal fixation occurred. The X-ray films showed stable ankle joint, anatomic or near anatomic reduction of the tibiotalar articular surface, normal alignment of distal tibia, and good bony healing. At 6 to 12 months after operation, the flexion and extension of the ankle were normal, without pain of the ankle joint after removal of internal fixation. According to Mazur et al. rating system for ankle symptoms and function, the results were excellent in 5 cases, good in 12 cases, fair in 5 cases, and poor in 3 cases; the excellent and good rate was 68%.

CONCLUSION: The procedure by anterior ankle lateral approach and posterolateral fibular approach can completely expose the tibiotalar articular surface, which is advantageous to displaced fracture reduction and fixation, and can achieve good effectiveness in treating Rüedi-Allgöwer III type Pilon fractures.