الفهرس 
Anatomy Linked to Four Column TheoryOnly 14 pages are availabe for public view
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Abstract
Introduction: Anatomical reduction and fixation of posterior column in Pilon fractures is directly related to patients’ syndesmotic stability and final clinical outcome. Purpose of our study is to assess and compare results of anterior to posterior screws (AP screws) versus posterior buttress plate in management of these fractures as regards functional, radiological outcomes and possible complications.
Materials and Methods: 30 patients with Pilon fracture involving posterior column were enrolled in this randomized controlled trial. Patients were randomized in two groups: direct reduction with fixation by posterior buttress plating (group A) and indirect reduction with fixation by AP screws (group B). Inclusion criteria included two, three and four column fracture according to four column theory. Exclusion criteria included pediatric age group with open physis, pathological fractures, open fractures and fractures with neurovascular injuries. Quality of reduction was evaluated using postoperative plain radiographs and computed tomography (CT). American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score was used for measurement of final clinical outcome.
Results: There was no statistically significant difference between group A and group B regarding mean time of union (p=0.264). Anatomical reduction was achieved in 80% and 26.7% of the A and B groups, respectively. Quality of reduction was significantly higher in group A compared to group B (p=0.003). There was no statistically significant difference between the two groups regarding complication rate (p=0.666). AOFAS score was significantly higher in group A compared to group B (p=0.030).
Conclusion: Both AP screws through indirect reduction and posterior buttress plating through direct reduction by posterolateral approach can be used in fixation of posterior column in pilon fractures involving two, three and four columns and lead to fracture union. However, we concluded that posterior plating can achieve better reduction and better overall functional clinical outcome represented by AOFAS score