Treatment of AO/OTA type 43-C3 pilon fractures with a combination of miniplate and main plate: a retrospective analysis.

Background: AO/OTA type 43-C3 pilon fractures are complex distal tibial fractures associated with high disability rates, surgical challenges, and frequent postoperative complications. Effective treatment of type-C3 pilon fracture remains an important research focus. This study aimed to evaluate the efficacy of a combined miniplate and main plate fixation strategy compared to traditional treatment methods.

Methods: A retrospective analysis was conducted on 64 patients with type 43-C3 pilon fractures treated between June 2018 and June 2022. Patients were divided into a miniplate group (MP group, n = 31) and a traditional treatment group (TT group, n = 33). Outcomes including operative duration, reduction quality, fracture healing, complications, functional scores (AOFAS, VAS, ROM), and hospitalization data were analyzed.

Results: The surgery was completed successfully in both groups, and the average follow-up duration was 16.78 ± 3.27 months. There were no significant differences in the duration of preoperative waiting, hospital stay, and weight-bearing between the two groups (P > 0.05). The duration of surgery was significantly shorter in the MP group than in the TT group (P < 0.05). The quality of fracture reduction and healing at 6 weeks after surgery in the MP group was significantly better than that in the TT group (P < 0.05). There was no significant difference in the visual analog scale scores between the two groups. However, at 6 months postoperatively and at the last follow-up, the American Orthopedic Foot and Ankle Society score and ankle fire activity range of motion were significantly better for those in the TT group. There were two cases of ischemic osteonecrosis, two of poor incision healing, and one of severely poor wound healing in the TT group; however, only one patient in the MP group had poor incision healing.

Conclusion: The use of miniplates combined with main plates in the treatment of type-C3 pilon fracture has obvious advantages, which simplifies the difficulty of the surgery, reduces the volume of the ankle joint, reduces postoperative complications, and is beneficial to postoperative exercise and ankle function recovery.