Efficacy of the four-step fixed-base reconstruction method for Rüedi–Allgöwer Ⅲ Pilon fracture

BACKGROUND: Rüedi-Allgöwer Ⅲ Pilon fractures represent extremely complex injuries with notable therapeutic challenges. Herein, we propose a novel, reliable, and reproducible method: the four-step fixed-base reconstruction method, performed via an internal plating-assisted single-incision anterolateral approach. METHOD: A retrospective study was conducted on 168 cases with Rüedi-Allgöwer type III Pilon fractures treated using either the four-step base-fixed reconstruction method utilizing internal plating-assisted single-incision anterolateral approach (four-step reconstruction group) or the traditional double-plate fixation method (traditional group). Preoperative and postoperative length of stay, operation time, frequency of intraoperative fluoroscopy, intraoperative blood loss, fracture healing time, complication rates, and postoperative outcomes at two years, including the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, visual analog scale (VAS) pain score, Mazur ankle score, and range of motion (ROM) during ankle dorsiflexion and plantarflexion, were thoroughly documented and compared. RESULTS: Compared with the traditional group, the four-step reconstruction group exhibited significantly shorter postoperative length of stay and operation time (P < 0.05), fewer intraoperative fluoroscopies, less intraoperative blood loss, and lower complication rates (P < 0.05). Additionally, the four-step reconstruction group demonstrated significantly higher AOFAS and Mazur scores (P < 0.05) and greater ankle dorsiflexion (P < 0.05). No significant differences were found between the groups regarding preoperative hospital stays, fracture healing times, VAS scores, or ankle plantarflexion angles. CONCLUSIONS: The four-step fixed-base reconstruction method utilizing internal plating-assisted single-incision anterolateral approach is one of the recommended options for the management of Rüedi-Allgöwer Ⅲ Pilon fractures.