OBJECTIVETo evaluate the influence of operative time on treating high-energy tibial Pilon fracture.

METHODSFrom June 2003 to May 2008, Sixty-five patients with tibial Pilon fracture were followed up. There were 42 males and 23 females in the study. The age was from 15 to 62 years with an average of (37.53 +/- 6.32) years. The patients were divided into two groups (group A and B) according to operative time. In the group A, 30 cases were treated with open reduction internal fixation (ORIF) at 3-7 days after injury. In the group B, 35 cases were treated with step-by-step postphoned ORIF at 7-24 days after injury (the swell of soft tissue extincted). The clinical effects were evaluated between two groups according to Bourne standard.

RESULTSAll patients were followed up from 7 to 24 months with an average of 16.23 months. There was significant difference on the early complications between two groups. In group A, 3 cases of infection, 4 cases of edge splitting, 1 case of plate explosing and 1 case of osteomyelitis. In group B, only 2 cases of surface infection. The time of fracture healing in group A and B was respectively (18.3 +/- 3.2) weeks and (15.7 +/- 2.5) weeks. There was significant difference between two groups (P < 0.05). According to the Bourne Pilon fracture healing standard,in group A, 12 cases got excellent result, 10 good, 8 poor, the rate of excellent and good was 73.3%; in group B, 21 cases got excellent result, 8 good, 6 poor, the rate of excellent and good was 82.9%. There was significant difference between two groups (P < 0.05).

CONCLUSIONThe choice of operative time is the key to treat high-energy tibial Pilon fracture. Step-by-step postphoned ORIF is an effective method for high-energy tibial Pilon fracture.