PMID- 24397129 OWN - NLM STAT- MEDLINE DCOM- 20140702 LR - 20161128 IS - 1002-1892 (Print) IS - 1002-1892 (Linking) VI - 27 IP - 10 DP - 2013 Oct TI - [Effectiveness and biomechanical analysis of three fixation methods in treatment of posterior Pilon fractures]. PG - 1190-5 AB - OBJECTIVE: To investigate the effectiveness and biomechanical analysis of 3 fixation methods of screw anterior-posterior fixation (SAPF), screw posterior-anterior fixation (SPAF), and buttress plate fixation (BPF) in treatment of posterior Pilon fractures. METHODS: Fifteen fresh-frozen skeleto-ligamentous lower leg specimens were harvested to establish the models of posterior Pilon fracture, and then fracture was fixed with BPF (n = 5), SAPF (n = 5), and SPAF (n = 5). Vertical force was loaded to internal fixation failure in a speed of 1 cm/minute with servohydraulic testing machine. The instantaneous loads of 1 mm and 2 mm steps and the failure modes were recorded. Between May 2008 and December 2011, 56 patients with posterior Pilon fracture were treated with SAPF (SAPF group) in 11 cases, or SPAF (SPAF group) in 26 cases, or BPF (BPF group) in 19 cases. There was no significant difference in age, gender, injury cause, side, disease duration, and complications among groups (P > 0.05). Clinical and radiographic examinations were used to assess the reduction and healing of fracture; the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and the visual analogue scale (VAS) were used to evaluate the functional outcomes. RESULTS: No breaking or bending was observed in all specimens, fixation failure was caused by cancellous bone compression. The instantaneous loads of 1 mm and 2 mm steps were the largest in BPF group, larger in SPAF group, and smallest in SAPF group, showing significant differences among 3 groups (P < 0.05). A total of 47 cases were followed up 16-54 months (9 in SAPF group, 22 in SPAF group, and 16 in BPF group), with a mean time of 35.2 months. Fixation failure was found in 2 cases of SAPF group; the other cases obtain bony union within 3 to 4 months (mean, 3.2 months) with no fixation failure. The AOFAS score was significantly lower in SAPF group than in SPAF and BPF groups (P < 0.05), but no significant difference was found between SPAF and BPF groups (P > 0.05). The VAS score was significantly higher in SAPF group than in SPAF and BPF groups (P < 0.05), but no significant difference was found between SPAF and BPF groups (P > 0.05). CONCLUSION: SAPF could not reach enough fixation strength for the posterior Pilon fracture; both SPAF and BPF could reach rigid fixation, and have good effectiveness. And from the biomechanical points, BPF could reach better fixation strength than screw fixations. FAU - Zhao, Hongmou AU - Zhao H AD - Department of Foot and Ankle Surgery, Honghui Hospital Affiliated to the Medical College of Xi'an Jiaotong University, Xi'an Shaanxi 710054, PR China. FAU - Liang, Xiaojun AU - Liang X AD - Department of Foot and Ankle Surgery, Honghui Hospital Affiliated to the Medical College of Xi'an Jiaotong University, Xi'an Shaanxi 710054, PR China. FAU - Yu, Guangrong AU - Yu G AD - Department of Foot and Ankle Surgery, Honghui Hospital Affiliated to the Medical College of Xi'an Jiaotong University, Xi'an Shaanxi 710054, PR China. FAU - Li, Yi AU - Li Y AD - Department of Foot and Ankle Surgery, Honghui Hospital Affiliated to the Medical College of Xi'an Jiaotong University, Xi'an Shaanxi 710054, PR China. FAU - Lu, Jun AU - Lu J AD - Department of Foot and Ankle Surgery, Honghui Hospital Affiliated to the Medical College of Xi'an Jiaotong University, Xi'an Shaanxi 710054, PR China. FAU - Zhang, Dongsheng AU - Zhang D AD - Department of Mechanics, Shanghai University, PR China. LA - chi PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't PL - China TA - Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi JT - Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery JID - 9425194 SB - IM MH - Adult MH - Aged MH - Ankle Injuries/diagnostic imaging/*surgery MH - Ankle Joint/diagnostic imaging/surgery MH - Biomechanical Phenomena MH - *Bone Plates MH - Bone Screws MH - Female MH - Fracture Fixation, Internal/*methods MH - Fracture Healing MH - Fractures, Bone/diagnostic imaging/*surgery MH - Fractures, Closed/diagnostic imaging/surgery MH - Humans MH - Male MH - Middle Aged MH - Radiography MH - Retrospective Studies MH - Tibial Fractures/diagnostic imaging/surgery MH - Treatment Outcome MH - Young Adult EDAT- 2014/01/09 06:00 MHDA- 2014/07/06 06:00 CRDT- 2014/01/09 06:00 PHST- 2014/01/09 06:00 [entrez] PHST- 2014/01/09 06:00 [pubmed] PHST- 2014/07/06 06:00 [medline] PST - ppublish SO - Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2013 Oct;27(10):1190-5.