BACKGROUNDOperative decision-making of Pilon fractures are of great challenges until now. The aim of this study was to investigate the guidance of the four-column theory in decision-making therapeutic strategies for Pilon fractures and its result.

METHODSOne hundred and ten cases (107 patients) of Pilon fractures classified by the four-column theory and treated by ORIF, were reviewed. According to the four-column classification scheme, lateral column of 85 cases, posterior column of 66 cases, medial column of 77 cases, and anterior column of 61 cases are involved. Among all the 110 cases, single column of 14 cases, two columns of 46 cases, three columns of 17 cases, and all of four columns of 33 cases are involved.

RESULTSOne hundred and eight cases have been followed up. The average follow up time is 14.7 months, varying between 7 and 52 months. The average healing time is 3.6 months, ranging from 2.5 to 8.0 months. Reduction of 86.1% reviewed Pilon cases are good or acceptable according to Burwell and Charley's Radiology Evaluation System. Ankle function of 87.1% cases are excellent or good according to the AOFAS evaluation system.

CONCLUSIONAs a simple and comprehensive classification, the four-column classification can contribute to reasonable operation decision-making and good prognosis of Pilon fracture.