Clinical efficacy of extended modified posteromedial approach versus posterolateral approach for surgical treatment of posterior pilon fracture: a retrospective analysis

Abstract

Background: Posterior pilon fracture is a type of ankle fracture associated with poorer treatment results compared to the conventional ankle fracture. This is partly related to the lack of consensus on the classification, approach selection, and internal fixation method for this type of fracture. This study aimed to investigate the clinical efficacy of posterolateral approach versus extended modified posteromedial approach for surgical treatment of posterior pilon fracture. Methods: Data of 67 patients with posterior pilon fracture who received fixation with a buttress plate between January 2015 and December 2018 were retrospectively reviewed. Patients received steel plate fixation through either the posterolateral approach (n = 35, group A) or the extended modified posteromedial approach (n = 32, group B). Operation time, intraoperative blood loss, excellent and good rate of reduction, fracture healing time, American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale score, and Visual Analogue Scale score were compared between groups A and B. Results: All patients were followed up for an average period of 15.4 months. No nonunion, failure of internal fixation, or anklebone stiffness occurred in either group during the follow-up period. However, the operation time was significantly shorter, intraoperative blood loss was significantly lower, AOFAS Ankle-Hindfoot Scale score was significantly higher, and Visual Analogue Scale score was significantly lower in group B than in group A (P < 0.05). Conclusion: Compared to the posterolateral approach, the extended modified posteromedial approach can provide a better surgical field for the treatment of posterior pilon fracture, which allows reduction and fixation of this type of fractures under direct vision and evaluation of reduction effects, and reduces operation time and intraoperative blood loss. Combining this approach with supporting steel plate fixation enables early functional rehabilitation of the ankle with more satisfactory clinical results.