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: Ankle trauma—pilon fractures
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
Day 0 Fracture classification 4 3 C 3
Discussion What are the goals of treatment? Day 0
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
Preoperative planning is essential
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 Standard and locking screws
Immediate postoperative rehabilitation protocols?
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 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
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