Application of the extended anterolateral approach in valgus pilon fractures combined with fibula fractures
Objective:To evaluate the efficacy of the extended anterolateral approach in the surgical management of valgus pilon fractures combined with fibula fractures.Methods:A retrospective analysis was conducted on the clinical data of 37 patients with valgus pilon fractures combined with fibular fractures at Foshan Hospital of Traditional Chinese Medicine from September 2016 to June 2023,including 24 males and 13 females,with an average of 38.6±6.4(ranging 21-55)years.According to the AO/OTA classification,there were 6 cases with type 43C1,11 cases with type 43C2,and 20 cases with type 43C3.All patients underwent extended anterolateral approach surgery.Postoperative follow-up included assessment of fracture healing,and at the last follow-up,the Visual Analog Scale(VAS)for pain and the American Orthopaedic Foot&Ankle Society(AOFAS)Ankle-Hindfoot Scale scores were recorded.Results:All surgeries were successfully completed.The operation time ranged from 86 to 136 minutes,with an average of(108.2±12.1)minutes,the intraoperative blood loss ranged from 53 to 110 mL,with an average of(78.3±15.3)mL,and the hospital stay ranged from 12 to 22 days,with an average of(15.2±2.6)days.Anteroposterior and lateral X-ray images of the ankle joint at 3 days postoperatively showed excellent fracture reduction in 14 cases(37.8%),good reduction in 22 cases(59.5%),and fair reduction in 1 case(2.7%),resulting in an excellent and good rate of 97.3%.By the 15th postoperative day,34 patients(91.9%)had grade A incision healing,and 3 cases(8.1%)had grade B healing.The time to fracture healing was(13.8±1.1)weeks.Patients were followed up for 13-22 months,with an average of(15.9±2.5)months,and there was no loosening or breakage of internal fixation until the last follow-up.At the last follow-up,the VAS pain score was 0 to 2 points,with an average of(0.8±0.6)points,and the AOFAS Ankle-Hindfoot score was(85.1±5.1)points,with 12 cases(32.4%)rated excellent and 23 cases(62.2%)rated good.Conclusions:The extended anterolateral approach can provide a good surgical view,stable fixation,low complication rates,and favorable postoperative joint function recovery.
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