![]() The patient was placed in the prone position, and a balloon tourniquet was used, then performing routine disinfection and laying a towel. Intraoperative anesthesia was performed using a laryngeal mask combined with a lower limb nerve block on the affected side. For patients with open commuted Pilon fractures or with fracture-dislocations of the ankle, an external fixator was preferred to stabilize the fracture after a preliminary manual reduction, which facilitated the protection of soft tissue and secondary internal fixation. Surgical treatment would be postponed until the swelling had subsided completely. ![]() In patients with serious soft tissue injuries, such as exudate or hematoma blisters, the wounds will be rinsed and partially sutured in the first stage. The two-mean comparison is based on t-test analysis and p < 0.05 is considered statistically significant.Īccording to the symptoms and fracture displacement, all patients were treated with manual reduction and plaster fixation or calcaneal traction before surgery, then admitted to the hospital, and given symptomatic treatment such as ice compresses, detumescence and pain relievers. The ankle and back foot scoring criteria of AOFAS and are represented by the X ¯ ± SD before and after follow-up. Statistical analysis is performed by means of SPSS 13. Regular follow-ups were carried out at 4–6 weeks, 12–16 weeks, 6 months, 1 year and 18 months. 7 A visual analogue scale was used to evaluate ankle joint pain when walking and resting. ![]() The healing quality of fracture reset is determined according to picture archiving and communication system imaging evaluation. 6 The score of 90–100 points as excellent, 75 - 89 points as good, 50 - 74 points as available, and < 50 points as poor. The summary analysis is as follows.Īccording to the scoring system of the American association of foot and ankle society (AOFAS), combined with preoperative and postoperative imaging data, and some aspects of patient's pain, ankle joint activity, shoe requirements, maximum walking distance, ground requirements and gait feedback, it is comprehensively scored with 7 rating categories. The author conducted a retrospective analysis of 20 patients with Klammer III posterior Pilon fractures who underwent improved internal fixation surgery in the author's department from January 2018 to December 2019. 4, 5 Since 2013, our department has used the modified posteromedial approach to handle such fractures. 3 Because posterior Pilon fractures extend both backwards and forwards, the ankle commonly used in the posterolateral approach cannot be fully exposed. 2 The type I fracture involves the entire posterior malleolus and has a long oblique base towards the posterolateral side the type II fracture line of the posterior malleolus extends to the inner side of the posterior colliculus the type III consists of separate medial and lateral bone masses, involving the posterior and anterior hills of medial malleolus, which are accompanied by dislocation and serious soft tissue damage. The Klammer classification is commonly used to clinically evaluate such fractures. Modern orthopaedic medicine has named these “posterior Pilon fractures”. Often ankle joint dislocations and injuries of the ankle joint cartilage surface are merged. A special type of trimalleolar fracture is caused by a vertical merger force, as a result of which the fracture line of the posterior malleolus along the distal tibia coronal surface extends to the medial malleolus hill. With the development of the construction industry, ankle lesions caused by falling are increasing. The mechanism of damage is rotational violence. Trimalleolar fracture is a clinically common type of traumatic fracture.
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