title: [Effectiveness and biomechanical analysis of three fixation methods in treatment of posterior Pilon fractures].
abstract: 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Foot and Ankle Surgery, Honghui Hospital Affiliated to the Medical College of Xi'an Jiaotong University, Xi'an Shaanxi 710054, PR China.
authors.forename: Hongmou
authors.initials: H
authors.lastname: Zhao
authors.affiliation: Department of Foot and Ankle Surgery, Honghui Hospital Affiliated to the Medical College of Xi'an Jiaotong University, Xi'an Shaanxi 710054, PR China.
authors.forename: Xiaojun
authors.initials: X
authors.lastname: Liang
authors.affiliation: Department of Foot and Ankle Surgery, Honghui Hospital Affiliated to the Medical College of Xi'an Jiaotong University, Xi'an Shaanxi 710054, PR China.
authors.forename: Guangrong
authors.initials: G
authors.lastname: Yu
authors.affiliation: Department of Foot and Ankle Surgery, Honghui Hospital Affiliated to the Medical College of Xi'an Jiaotong University, Xi'an Shaanxi 710054, PR China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Foot and Ankle Surgery, Honghui Hospital Affiliated to the Medical College of Xi'an Jiaotong University, Xi'an Shaanxi 710054, PR China.
authors.forename: Jun
authors.initials: J
authors.lastname: Lu
authors.affiliation: Department of Mechanics, Shanghai University, PR China.
authors.forename: Dongsheng
authors.initials: D
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000368:Aged; D016512:Ankle Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D000843:Ankle Joint / Q000000981:diagnostic imaging / Q000601:surgery; D001696:Biomechanical Phenomena; D001860:Bone Plates; D001863:Bone Screws; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D017102:Fracture Healing; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D005596:Fractures, Closed / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult