Pilon Fracture
Result of high energy trauma resulting with a heavy axial force of talus which bursts tibial plafond over talus
AP radiograph of Ankle shows a multifragmentary Pilon fracture.
https://ota.org/for-patients/find-info-body-part/4687
How do you approach ?
ATLS review
R/o concomitant injuries
R/o compartment syndrome
NV status , observe signs of open injury or degloving injury
temporary splinting, analgesia, obtain AP/Lateral views and CT -study
plan and do definitive management
Classification of Pilon Fractures
Type 1 - essentially non-displaced
2 - displaced with communition
3 - metaphyseal or articular communition
What is the primary treatment for this fracture ?
monitor signs of compartment syndrome
transfer to theatre
place an ex-fixator - damage control surgery
keep limb out to length
maintain alignment to avoid further insult to soft tissues
+/- fix fibula at the same setting to restore length
What is the definitive treatment ?
CT-scan -preoperative planning
Wait 7-10 days for soft tissues to be in appropriate condition for surgery
Openly reduce and fix along AO (Arbeitsgemeinschaft fur Osteosynthesefragen ) principles
Non-surgical treatment - an option but gives a poor result
Surgical Treatment - Ex fixator such as fine wire Ilizarov frame.
ORIF with Plating
Goals -
anatomical reconstruction of articular surfaces
restoration of correct rotational alignment
https://journals.sagepub.com/doi/10.1177/0036933015569159
Complications to warn the patients
Short term
Wound break down
Infection
Compartment syndrome
Complex Regional Pain Syndrome(CRPS)
Mid Term
Non-union
Mal-union
Long term
Limitations of ankle movement
Post-traumatic OA - 80 %
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