Two posteromedial approaches in treatment of posterior pilon fractures of Klammer type III

Objective To observe operative results of 2 posteromedial approaches in the treatment of posterior pilon fractures of Klammer type Ⅲ. Methods From January 2015 to December 2016, 19 patients with posterior pilon fracture (Klammer type Ⅲ) were treated via the posteromedial approach. They were 12 men and 7 women, aged from 21 to 61 years (mean, 37.4 years). Straight posteromedial incision was used in 11 cases and curved posteromedial incision in the other 8 cases. The 2 groups were compared in terms of postoperative wound complication, infection, bone union, visual analogue scale (VAS) and American Orthopedic Foot and Ankle Society (AOFAS) scores. Results Follow-up ranged from 6 to 29 months (mean, 11.8 months). All the fractures united after 6 to 15 months (mean, 10.7 months). In the straight incision group, the VAS scores at the final follow-up ranged from 0 to 3 points, averaging 1.1 points; the AOFAS scores ranged from 83 to 100 points, averaging 90.8 points. In the curved incision group, the VAS scores at the final follow-up ranged from 0 to 3 points, averaging 1.3 points; the AOFAS scores ranged from 80 to 100 points, averaging 90.1 points. In one case in the curved incision group, the posteromedial wound failed to heal but scar healing was achieved after dressing change for 4 months. Conclusion The posteromedial approach, whether straight or curved, can provide good exposure for posterior pilon fractures of Klammer type Ⅲ, which is conductive to reduction and fixation of the fracture. Key words: Ankle injury; Fractures, bone; Fracture fixation, internal; Posterior pilon; Approach