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To evaluate the effect and complication of surgical treatment for Pilon fracture using the posterolateral approach.From August 2009 to March 2011, 15 patients with Pilon fractures (2 in B3,13 in C) and with a separate displaced posterior malleolar fragment was treated in two-stage: the first stage management was on stabiliztion of the soft tissue envelope with temporary external fixator of spanning arthritis, and the second stage management was open reduction and internal fixation with posterolateral approach and anteromedial or anteralateral approach.All patients were followed-up for 12 to 17 months (14.2 months in average). Thirteen of the 15 fractures healed, but 2 fractures needed autologous bone graft procedure duo to nonuion. There was no wound complication related to poterolateral incion. Fourteen fractures had less than 2 mm of incongruity of distal tibia joint. According to Baired-Jackson criteria, the results were excellent in 2 cases, good in 7, fair in 4, and poor in 2.The posterolateral approach offers direct visualization for the reduction and fixation of the fibula and posterior distal fragment of the tibia Pilon fractures, faciliate the management of this difficult fracture pattern.

To discuss the indication and outcome of volar Barton fracture treated by nonoperative method.Twenty-three cases of volar Barton fracture treated by closed method included 8 male and 15 female with an average age of 52.2 years,ranging 16 to 84 years. Among them, 16 cases showed subluxation of the carpus (15 cases were Mehara type I ,1 case was Mehara type III) by radiographs except the other 7 cases. By the experimentation in 32 cadavers, the injury of dorsal radiocarpal ligament was supposed to be a very important cause of the subluxation of the radiocarpal joint. The criteria of Pattee and Thompson was used to evaluate the outcome of the treatment.Twenty-three patients were followed up for 7 to 70 months, 11 cases gained satisfactory outcome (1 case as excellent, 10 cases as good), 12 cases gained unsatisfactory outcome (5 cases as fair, 7 cases as poor). Five of 7 cases without the subluxation of the carpus by the radiographs gained satisfactory outcome. Six of 16 cases with the subluxation of the carpus gained satisfactory outcome.(1) The result of reduction will influence the outcome of the treatment, the step on articular surface shoud be less than 2 mm after reduction. (2) Nonoperative method is recommended if volar Barton fractures are not associated with subluxation of the carpus. (3) Nonoperative method can be tried first if the fractures associated with the subluxation of the carpus, however operation is recommended when the articular step is more than 2 mm.