Objective  To investigate the clinical effect of different internal fixation methods combined approach in the treatment of Klammer Ⅲ type posterior pilon fracture.

  Methods  Twenty patients with Klammer Ⅲ type posterior pilon fractures were retrospectively analyzed. Among them, 9 cases underwent internal fixation with hollow nails (hollow nail group), and 11 cases underwent internal fixation with steel plate or steelplate plus hollow nails (steel plate group). After surgery, Visual Analogue Scale (VAS) and American Orthopedic Foot Andankle Society (AOFAS) ankle-hindfoot scale were used to evaluate the efficacy.

  Results  Fracture healing was observed in all 20 patients, and skin necrosis occurred in 1 case after surgery, which healed after dressing change for 1 month. There was no fracture nonunion, fracture and loosening of plate and screw after operation. Compared with the patients before surgery, the VAS scores of patients 3 and 6 months after surgery were significantly decreased, and the AOFAS scores were significantly increased (P < 0.05). The preoperative VAS score in the steel plate group was significantly higher than that of patients with hollow nail fixation (P < 0.05). The postoperative VAS scores in two groups were decreased, and the difference was not statistically significant (P>0.05). The AOFAS score in the steel plate group was significantly higher than that of patients with hollow nail fixation 3 months after surgery (P < 0.05). At 6 months after surgery, AOFAS scores in two groups were increased, and the difference was not statistically significant (P>0.05).

  Conclusion  Klammer Ⅲ type posterior pilon fracture with cannulated nail or steel plate fixation for fracture reduction is effective, and internal fixation combined with approach can fully expose the fracture end, and has better postoperative effect.