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Abstract Objective To discuss operative technique and clinical result of posteromedial approach combined with Anterolateral limited incision for the treatment of Pilon fracture.Methods 10 cases tibial Pilon fractures were operated through posteromedial approach combined with anterolateral limited incision from March 2010 to January 2015，including 9 males and 1 female.Their ages were 24 to 56 years with an average of 36.5 years.The time until surgery was 5 hours to 14 days with an average of 9 days.All the cases were unilateral closed fractures with large posterior fracture fragments of diatal tibia，including 7 left and 3 right sides.The fractures were evaluated by AO/OTA classification，2 cases were type 43C1 and 8 cases were type 43C2.Soft tissue injury was evaluated by Tsherne classification.4 cases were grade 0，4 cases were grade 1 and 2 cases were grade 2.Fibular fracture and anterolateral distal tibia fracture fragments were reduced and fixed through Anterolateral limited incision.Posteromedial approach was used to expose posterior and medial fractures of distal tibia，and these fractures got good reduction and screw fixation.Through posteromedial approach a medial distal tibial locking plate was introduced to stabilize distial tibia by MIPPO technique.Results All the incisions healed well.All patients were followed up for 12 to 24 months and mean follow-up time was 16.5 months.The time to fractures healing was 12 to 24 weeks with an average of 15.1weeks.According to Mazur criterion，ankle function was excellent in 6 cases，good in 2 cases，fair in 2 cases，and the excellent and good rate was 80%.Conclusion The indication for posteromedial approach combined with anterolateral limited incision is closed Pilon fracture with large posterior fracture fragments of distal tibia.This technique can effectively expose，reduce and fix posterior and medial fracture fragments of distal tibia.It can decrease iatrogenic soft tissue injury，preserve the blood supply of fracture fragments，and has less complication rate and good treatment result.
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