title: Surgical treatment of pilon fracture based on ankle position at the time of injury/initial direction of fracture displacement: a prospective cohort study.
abstract: OBJECTIVE
  The purpose of this study is to evaluate a surgical strategy for pilon fractures based on ankle position/initial direction of fracture displacement at the time of injury.
  
  
  METHODS
  Sixty-nine patients were categorized into groups based on ankle position at the time of the injury: Group I (varus), Group II (valgus), Group III (dorsiflexion), Group IV (plantarflexion), and Group V (neutral). The American Orthopedic Foot and Ankle Society (AOFAS) score was determined at 12 months.
  
  
  RESULTS
  More than 90% of participants in Groups I-IV as well as 57.2% of participants in Group V had anatomic/good fracture reduction, respectively. Fracture healing/union was significantly slower in Group V vs Groups I, III, and IV, and in Group II vs Group IV (P < 0.005). AOFAS scores were significantly higher (P < 0.005) in Groups III (96.0, IQR: 90.0-96.0) and IV (95.0, IQR: 90.0-100.0) vs Groups II (86.9, IQR: 75.0-90.0) and V (83.0, IQR: 73.0-86.0). Wound breakdown was the most common complication (n = 11).
  
  
  CONCLUSIONS
  Determining the surgical strategy for managing pilon fractures based on ankle position at the time of the injury/initial direction of fracture displacement may be effective.
authors.affiliation: Department of Orthopaedic Surgery, Wuhan General Hospital of Guangzhou Command, No. 627 Wuluo Road, Hongshan Area, Wuhan 430070, China.
authors.forename: Shi-jun
authors.initials: SJ
authors.lastname: Wei
authors.affiliation: Department of Nutrition, Wuhan General Hospital of Guangzhou Command, Wuhan 430070, China.
authors.forename: Fang
authors.initials: F
authors.lastname: Han
authors.affiliation: Department of Orthopaedic Surgery, Wuhan General Hospital of Guangzhou Command, No. 627 Wuluo Road, Hongshan Area, Wuhan 430070, China.
authors.forename: Sheng-hui
authors.initials: SH
authors.lastname: Lan
authors.affiliation: Department of Orthopaedic Surgery, Wuhan General Hospital of Guangzhou Command, No. 627 Wuluo Road, Hongshan Area, Wuhan 430070, China. Electronic address: wgcaixh@163.com.
authors.forename: Xian-hua
authors.initials: XH
authors.lastname: Cai
mesh_terms: D000328:Adult; D000842:Ankle; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D013978:Tibial Fractures / Q000601:surgery*
keywords: Distal tibial fracture; Intra-articular ankle fracture; Pilon fracture; Plafond fracture; Treatment protocol