Poor prognosis was reported for complex Pilon fractures involving severe soft tissue damage. It is therefore useful to explore the evolution of different treatment strategies in an effort to reconstruct the axial alignment and articular surface, while minimizing additional damage to the surrounding soft tissues. Seventeen patients with Pilon fractures were enrolled in this retrospective study from December 2009 to October 2014. The injuries were graded according to AO Classification and the Gustilo-Anderson system. Patients were treated with minimally invasive plate osteosynthesis (MIPO) combined with curved incision on the anterior area of ankle. The ankle function and radiological outcome were assessed by the modified Mazur ankle score and Burwell-Charnley criteria, respectively. Visual analogue score (VAS) score was used to assess the degree of patient’s ankle pain, and related complications were also recorded. The mean time for fracture healing was 3.6 months (range: 3–6 months). According to Mazur’s criteria, surgical treatment achieved good or excellent outcome in 15 (88.2%) cases, and the average VAS score was 1.19 ± 0.52. On the basis of Burwell-Charnley score, 12 (70.5%) patients achieved anatomic recovery, 4 (23.5%) obtained good reduction, and only 1 (5.9%) patient was diagnosed with valgus deformity. Additionally, 1 (5.9%) patient developed a superficial infection around incision, and 2 (11.8%) experienced superficial peroneal nerve damage. In addition, 2 (11.8%) patients showed radiographic evidence of existing ankle osteoarthritis at the final follow-up. This retrospective study is the first to assess the application of a curved incision on the anterior area of ankle with MIPO for the treatment of Pilon fractures, which achieves high functional recovery with a low complication rate. However, large randomized controlled trials comparing different approaches and fixation methods are still needed to conclusively identify the optimal treatment protocol.

中文翻译：

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新型前弯切口联合MIPO治疗Pilon骨折

据报道，涉及严重软组织损伤的复杂Pilon骨折预后较差。因此，有必要探索不同治疗策略的发展，以重建轴向对准和关节表面，同时最大程度地减少对周围软组织的损害。2009年12月至2014年10月，该回顾性研究纳入了17例Pilon骨折患者。根据AO分类和Gustilo-Anderson系统对损伤进行分级。患者接受微创钢板内固定（MIPO）结合踝前部弯曲切口治疗。分别通过修改后的Mazur踝关节评分和Burwell-Charnley标准评估踝关节功能和放射学结局。视觉模拟评分（VAS）评分用于评估患者的脚踝疼痛程度，并记录相关并发症。骨折愈合的平均时间为3.6个月（范围：3-6个月）。根据Mazur的标准，手术治疗在15例（88.2％）病例中取得了良好或优异的结果，平均VAS评分为1.19±0.52。根据Burwell-Charnley评分，有12例（70.5％）的患者实现了解剖恢复，4例（23.5％）的复位良好，只有1例（5.9％）被诊断为外翻畸形。此外，有1名（5.9％）患者在切口周围出现了浅表感染，而2名（11.8％）则经历了腓骨浅表神经损伤。此外，有2名（11.8％）的患者在最后一次随访中表现出存在踝关节骨关节炎的影像学证据。这项回顾性研究是第一个评估在MIPO的踝关节前部弯曲切口在治疗Pilon骨折中的应用的方法，该疗法可实现高功能恢复且并发症发生率低。然而，仍然需要比较不同方法和固定方法的大型随机对照试验来最终确定最佳治疗方案。