Objective: To explore the clinical outcomes of open reduction and internal fixation by posterolateral and posteromedial approaches for treating posterior Pilon fractures in elderly patients.
Methods: Between August 2009 and August 2014, 20 elderly patients with posterior Pilon fractures were treated with open reduction and internal fixation by posterolateral and posteromedial approaches. There were 14 males and 6 females, aged from 66 to 83 years (mean, 72.7 years). The causes were falling injury in 11 cases and traffic accident injury in 9 cases. All the patients had lateral malleolus and medial malleolus fractures. The time from injury to operation was 7-14 days (mean, 8.6 days). The posterolateral incision was made to expose the posterolateral bone fragments of posterior malleolus and lateral malleolus fracture, and the posteromedial incision was made to expose the posteromedial fracture fragments of posterior malleolus and medial malleolus fracture. After reduction, fracture was fixed with locking plate or cannulated screw. All the patients began to functional exercise at 1 day after operation.
Results: The operation time was 60-110 minutes (mean, 92 minutes). The incisions healed primarily in all patients. There were no complications of incision dehiscence, infection, implant exposure, and nerve damage. No irritation sign of tendon was observed. All 20 cases were followed up for 12-18 months (mean, 13 months). The X-ray films showed that fracture healed at 3-9 months, with an average of 5.2 months. During follow-up period, no loosening or breakage of the implant was observed. The other patients could walk normally except 2 patients (over 80 years old) who could walk with crutch. According to American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, the results were excellent in 12 cases, good in 4 cases, and fair in 4 cases; the excellent and good rate was 80%.
Conclusions: A combination of posterolateral approach and posteromedial approach for open reduction and fixation of posterior Pilon fractures can achieve satisfactory effect in elderly patients. It has the advantages of protecting ankle blood supply and avoiding the soft tissue necrosis and implants exposure.
目的: 探讨采用后外及后内侧联合入路切开复位内固定治疗老年后Pilon骨折的疗效。.
方法: 2009年8月－2014年8月，收治后Pilon骨折老年患者20例。男14例，女6例；年龄66~83岁，平均72.7岁。致伤原因：摔伤11例，交通事故伤9例。均伴内、外踝骨折。伤后至手术时间7~14 d，平均8.6 d。采用后外侧切口暴露后踝外侧骨折块以及外踝骨折，后内侧切口暴露后踝内侧骨折块以及内踝骨折；直视下骨折复位后，采用锁定钢板或空心螺钉固定。术后第1天即开始功能锻炼。.
结果: 手术时间60~110 min，平均为92 min。患者切口均Ⅰ期愈合，无切口裂开、感染、内固定物外露及神经损伤症状，未出现腓骨肌腱刺激症状。20例患者均获随访，随访时间12~18个月，平均13个月。X线片复查示，骨折均愈合，愈合时间3~9个月，平均5.2个月；随访期间无钢板螺钉松动、断裂发生。除2例80岁以上患者需扶拐行走外，其余患者均恢复正常行走。末次随访时，根据美国矫形足踝协会（AOFAS）踝与后足评分标准评价踝关节功能：优12例，良4例，可4例，优良率80%。.
结论: 采用后外及后内侧联合入路切开复位内固定治疗老年后Pilon骨折，保护了踝关节周围血运，能避免软组织坏死、内固定物外露，取得满意效果。.
Keywords: Ankle; Elderly patient; Internal fixation; Posterior Pilon fracture.