Treatment of pilon fractures of Rüedi-Allg(o)wer types II and III via anterior intermediate incision with L-shaped anatomical locking compression plate

Objective To observe the therapeutic results of treating pilon fractures of Riedi-Allg(o)wer types Ⅱ and Ⅲ via the anterior intermediate incision with an L-shaped anatomical locking compression plate (LCP).Methods From January 2011 to June 2013,18 patients with pilon fractures of Ruedi-Allg(o)wer types Ⅱ and Ⅲ received surgery in our department.They were 13 males and 5 females,aged from 23 to 76 years (average,48.1 years).Eight cases were type Ⅱ and 10 cases type Ⅲ; 12 cases were closed and 6 cases open; 4 cases had concomitant ankle dislocation.For open fractures,fibular reduction and internal fixation plus a medial spanning external fixator was performed at the first stage,followed by tibial open reduction and internal plating after removal of the external fixator (10 days on average) at the second stage.For closed injury,we adopted staged therapy.The patients underwent fibular reduction and internal fixation through the posterolateral incision,followed by reduction and fixation of the chaput tubercle through the anterior intermediate incision.The articular surface of the middle ankle column and bone fragments of the medial column were reduced the way as for the chaput tubercle,and fixated with an L-shaped anatomical LCP at the tibial metaphysis.Results All patients were followed up for an average of 12 months (from 6 to 24 months).According to the Burwell-Charnley radiological criteria,anatomical reduction was achieved in 14 cases,and fair reduction in 4.All the fractures healed after a mean period of 14 weeks.According to the Mazur clinical criteria,ankle functions were rated as excellent in 10 cases,good in 6,and fair in 2.Conclusions In staged treatment of tibial pilon fractures of Ruedi-Allg(o)wer types Ⅱ and Ⅲ,reduction and fixation with anatomical L-shaped anatomical LCP via the anterior intermediate incision can result in stable fixation,a high rate of bone union,limited incision-related complications and satisfactory functional recovery.Restoring stability of the ankle lateral column is extremely important in the treatment of tibial pilon fractures. Key words: Tibial;  Fracture fixation, internal;  Bone plates;  Dislocations