The posterior Pilon fracture: treatment and results via a posterolateral approach

[Objective]This study was designed to describe the fracture patterns and early results of operations of posterior Pilon fractures through a posterolateral approach.[Method]This study consisted of 14 cases,10 males and 4 females with the mean age of 47 years(range,28-63 years).The causes were traffic accident in 2,falling in 6 and sprain injuries in 6 cases.The duration from injury to operation was 7-14 days.Including 12 cases combined with distal fibula fracture and3 cases with medial malleolus fracture.There were 3 posterior dislocation fracture.All cases were treated with open reduction and internal fixation(ORIF).[Result]A consistent fracture pattern was identified with a primary,inferiorly posterior Pilon fracture that likely occur through a combined rotational and axial load mechanism.The average duration of follow-up was 26(range,24-37)months.The postoperation average of American Orthopedic Foot Ankle Society score(AOFAS)was 92points which was much higher than before operation.Anatomical reduction were obtained in all cases.Two complications(1wound superficial infection and 1 sural cutaneous nerve injury)were all managed nonoperatively.[Conclusion]Posterior Pilon fractures form a consistent pattern.They can be successfully managed through a posterolateral approach with direct reduction and buttress fixation of articular fragments.