12/22/2023 0 Comments Pilon fracture![]() In contrast to simple ankle fractures, pilon fractures usually result from high-energy trauma with heavy axial force, which basically causes the tibial plafond to burst over the talus ( 7). Furthermore, in recent studies it has been suggested that tibial pilon fractures are likely to be less comminuted and less severe when the fibula remains intact ( 6). Tibial pilon fractures with the fibula intact are more likely in AO Type B fractures than in Type C fractures. In ~75–90% of all cases the fibula is also fractured ( 5). Men tend to suffer from these injuries slightly more often than women with the majority of injuries occurring at around 45 years ( 3, 4). Tibial pilon fractures are quite rare, accounting for ~3–10% of all tibial fractures and <1% of all fractures to the lower extremity ( 1– 3). The aim of this review is therefore to summarize protocols in managing these difficult fractures, review the literature on recent developments and therefore give surgeons a better understanding and ability to handle tibial pilon fractures. Additional methods of treating the soft tissue envelope are currently being investigated and have shown promising results for the future. In the early years of this century treatment has evolved to a two–staged protocol, which nowadays is the gold standard of care. Therefore, long -term outcome is often poor and correct initial management crucial. Especially Type C fractures are extremely difficult to manage as the high energy involved in developing this type of injury frequently damages the soft tissue surrounding the fracture zone severely. Many different classification systems exist so far, with the AO Classification being the most commonly used classification in the clinical setting. This term has further been used to portray the mechanism involved in tibial pilon fractures in which the distal tibia acts as a pestle with heavy axial forces over the talus basically causing the tibia to burst. He used the French word “pilon” (i.e., pestle), to describe the mechanical function of the distal tibia in the ankle joint. Tibial pilon fractures were first described by Étienne Destot in 1911. 3Department of Trauma Surgery, Center for Musculoskeletal Surgery, Charité University Medicine Berlin, Berlin, Germany.2Center for Orthopedic and Trauma Surgery, University Medical Center, Cologne, Germany.1Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.Braun 1,3, Chlodwig Kirchhoff 1, Peter Biberthaler 1 and Moritz Crönlein 1 Institution: The Queen Elizabeth Hospital, Birmingham, UK.Ĭlinicians should seek clarification on whether any implant demonstrated is licensed for use in their own country.Olivia Mair 1 *, Patrick Pflüger 1, Kai Hoffeld 1,2, Karl F. Internal fixation of distal tibial Pilon fracture using Stryker AxSOS 3Ti plate. Readers will also find of use the following operative techniques on OrthOracle dealing with pilon fractures:Ĭ-Type Pilon Fracture – Open Reduction and Internal Fixation with Stryker AxSOS 3 Periarticular Plating System The classification has been further refined by Topliss and Atkins who described the commonly seen articular fragments and patterns of injury.Ĭurrent management of high energy pilon fractures normally involves a staged approach with initial placement of an external fixator to resuscitate the soft tissues and restore overall limb alignment followed by definitive fixation once the soft tissues have recovered sufficiently. The majority of the injuries reported by Ruedi and Allogower occurred after skiing accidents, in contrast to this most injuries seen in less mountainous regions occur after high energy injuries involving axial loads to the ankle such as falls from significant height or road traffic accidents. They also provided a classification with 3 types, Type 1 with no joint displacement, type 2 with articular displacement and type 3 with significant articular comminution. Firstly restoration of fibula length, secondly reconstruction of the joint surface, thirdly bone grating to the metaphysis and fourthly a medial buttress plate. They advocated surgical fixation with a four stage approach. The operative fixation of pilon (pestle) fractures was first described by Ruedi and Allgower in 1968. Our e-learning platform contains high resolution images and a certified CME of the Pilon fracture: C-type fixed using Smith and Nephew EVOS small fragment system surgical procedure. Learn the Pilon fracture: C-type fixed using Smith and Nephew EVOS small fragment system surgical technique with step by step instructions on OrthOracle. Subscribe to get full access to this operation and the extensive Foot Surgery Atlas.
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