Aim: The pylon tibial fractures are a challenge for the orthopaedic surgeons. The purpose of this study was comparative analysis of different surgical methods of the pylon fractures.

Methods: From 1994 to 2003 143 pylon fractures were treated. There were 87 men and 56 women from 15 to 74 years old. In 45 cases we used only external fixation (Ilizarov apparatus), in 29 open reduction and screw fixation was combined with external fixations. Sixty eight fractures were treated by ORIF according AO principles. In 51 cases “clover leaf” and 1/3 tubular plates were used, in 18 cases stable fixation was realized by LCP-plates. Follow-up results were analyzed through 9 and 12 months.

Results: The good and excellent results (no pain, deformities and good function) were received in 72,7% patients, the satisfactory results – at 23,8 % cases. In 9 patients the superficial and in 4 the deep wound infection took place. The best results are received in cases of Locking Compression Plate (LCP) application.

Conclusions: Full restoration of axis and articular surface (with or without bone grafting), stable fixation and early mobilization of the joint is essential in successful treatment of pylon fractures. Indirect reduction and external fixation can be applied only in A and B1-type of fractures. At types B2,3 and C good results can be received only at use of a stable internal osteosynthesis.

Aims: The purpose of this study is comparative analysis of different surgical methods of calcaneal fractures treatment. Methods: From 1992 to 2001 we treated 132 patient (161 feet) with displaced intra-articular fractures of the calcaneus. All of these fractures have been classified according to the Essex-Lopresti Rx classification. 7 fractures were type A, 14 – type B1, 22 – type B2. Type C1 occurred in 51 cases, type C2- in 58 and type D – in 9 cases. 113 patients (134 feet) had fresh trauma (2–10 days after injury) and in 18 cases (27 feet) 3 up to 6 weeks passed from the moment of the injury. In 52 cases (62 feet) we used closed reduction and external fixation with Ilizarov apparatus. In other AO-implants were used: reconstruction 3,5 mm plate (19 cases), T-plate (12 cases), “Tampa plate”(59 feet) and new Locking Calcaneal Plate (9 feet). All patients underwent pre- and postoperative standard lateral and axial X-Ray and CT-scans. Follow-up results were analysed through 6 and 12 months. Results: Good and excellent results (no pain, no deformities and good function) were obtained in 74,2% patients, satisfactory results – in 18,2% of cases. In 7 patients the superficial skin necrosis was observed, in 5 cases deep wound infection developed. The best results are received in cases of Locking Calcaneal Plate application. Conclusions: Fractures of the calcaneus should be treated like other intra-articular fractures, i.e. careful reduction, stable fixation and early mobilization. Indirect reduction and external fixation can be applied only in A and B1-type of fractures. In fractures of B2 and C types good results can be obtained only by using stable osteosynthesis. In D-type fractures and neglected/delayed C2-fractures it is better to apply a primary sub-talar arthrodesis.