Pilon fracture Case for small group discussion AO

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Pilon fracture Case for small group discussion AO Trauma—Foot & Ankle Module 1 b:

Pilon fracture Case for small group discussion AO Trauma—Foot & Ankle Module 1 b: Ankle trauma—pilon fractures

Case description • • 19 -year-old man Chased by police, jumped 4 m Isolated,

Case description • • 19 -year-old man Chased by police, jumped 4 m Isolated, closed injury Hemodynamics OK No neurovascular problems Compartments OK Hip/knee OK Initial joint-bridging external fixation Day 0

Fracture classification Day 0

Fracture classification Day 0

Day 0 Fracture classification 4 3 C 3

Day 0 Fracture classification 4 3 C 3

Discussion What are the goals of treatment? Day 0

Discussion What are the goals of treatment? Day 0

Discussion What are the goals of treatment? • Anatomical joint reconstruction/reduction • Correct length,

Discussion What are the goals of treatment? • Anatomical joint reconstruction/reduction • Correct length, alignment, and rotation of the metaphysis • Normal ankle and limb function Day 0

What are the treatment options? Soft tissues are OK Day 12

What are the treatment options? Soft tissues are OK Day 12

Preoperative planning is essential

Preoperative planning is essential

Goal 1—anatomical joint reduction/ reconstruction • Open approach • Direct reduction • Lag screw

Goal 1—anatomical joint reduction/ reconstruction • Open approach • Direct reduction • Lag screw fixation Day 12

Goal 2—length, alignment, rotation of metaphysis • • Indirect reduction Percutaneous technique Bridge plate

Goal 2—length, alignment, rotation of metaphysis • • Indirect reduction Percutaneous technique Bridge plate Standard and locking screws

Immediate postoperative rehabilitation protocols?

Immediate postoperative rehabilitation protocols?

18 -month follow-up • Anatomical joint reconstruction • Correct length, alignment, and rotation of

18 -month follow-up • Anatomical joint reconstruction • Correct length, alignment, and rotation of the metaphysis • Normal ankle and limb function

Take-home messages • Realize the need for absolute and relative stability at different areas

Take-home messages • Realize the need for absolute and relative stability at different areas of the fracture • Think about the soft tissues • Have a preoperative plan • Understand indications for locked plating and intramedullary nailing • Evaluate risks and benefits of minimally invasive plate osteosynthesis