Jun-Young Lee; Sang-Joon Lee

doi:10.12671/jkfs.2014.27.2.173

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Current Concepts in Management of Pilon Fracture: Jun-Young Lee, M.D., Sang-Joon Lee, M.D.; Journal of the Korean Fracture Society 2014;27(2):173-184.
DOI: https://doi.org/10.12671/jkfs.2014.27.2.173
Published online: April 18, 2014

Department of Orthopaedic Surgery, School of Medicine, Chosun University, Gwangju, Korea.

Address reprint requests to: Jun-Young Lee, M.D. Department of Orthopaedic Surgery, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju 501-717, Korea. Tel: 82-62-220-3147, Fax: 82-62-226-3379, leejy88@chosun.ac.kr

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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REFERENCES

Financial support: None.

Conflict of interest: None.

REFERENCES

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Fig. 1

Mechanism of the axial load type injury. The ultimate fracture pattern depends on the direction and rate of application of the injury force, and on the position of the foot at the time of loading.

Fig. 2

(A) The patient has a pilon fracture with severe soft tissue swelling and blisters. (B, C) A temporary external fixator was applied in order to maintain the length and alignment of the lower leg and reduce the fracture.

Fig. 3

(A) The surgical incision of the anteromedial approach to metaphysis and the ankle joint has been marked out on the patient's left ankle. (B) Deep surgical exposure of the ankle joint using an anteromedial approach. (C, D) Immediate postoperative radiographs show a satisfactory articular reduction and restoration of distal tibial alignment by semi-tubular plate (Synthes®).

Fig. 4

(A, B) Injury anteroposterior and lateral radiographs of a displaced left tibial pilon fracture. (C) Large Volkmann fragment and Chaput fragment were observed. (D, E) Restoration of tibial length and joint spanning by temporary tibia external fixator. (F) Chaput fragment remained attached to the lateral malleolus; however, it was not reduced after reduction and plating of the associated fibular fracture. (G-J) Definitive open reduction and internal fixation was performed using an anterolateral surgical exposure and additional medial plating using the minimally invasive percutaneous osteosynthesis technique after resolution of soft tissue swelling.

Fig. 5

(A) Surgical incision of the posterolateral approach and posterolateral fibular plating was performed. (B) Volkmann fragment was observed after retraction of the peroneal tendon and buttress plating was possible. (C, D) Postoperative radiographs show a satisfactory articular reduction and restoration of distal tibial alignment.

Fig. 6

C3 pilon fracture with a medial open wound sustained by a male of 46 years (smoking history) as a result of a traffic accident. (A, B) Preoperative anteroposterior and lateral radiography. (C) Type II open wound at the medial aspect of the anterior tibia. (D, E) A temporary external fixator was applied in order to maintain the length and alignment of the lower leg and reduce the fracture. (F, G) Immediate postoperative radiographs show a satisfactory articular reduction and restoration of distal tibial alignment by locking the compression plate (Synthes®) in the second stage operation. (H-K) Bone union and satisfactory function of the ankle six months after the operation.

Fig. 7

(A) Initial photo of a pilon fracture with an open wound measuring 4 cm in size. (B) Photo of wound dehiscence three weeks after the initial injury. (C, D) It was treated with reverse sural artery flap.

Fig. 8

(A, B) Posttraumatic arthritis was developed by a pilon fracture. (C, D) Postoperative radiographs treated with total ankle arthroplasty.

Table 1

Comparison of Features between Rotational Injury and Axial Loading Injury

Figure & Data

REFERENCES

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Current Concepts in Management of Pilon Fracture

J Korean Fract Soc. 2014;27(2):173-184. Published online April 30, 2014

DOI: https://doi.org/10.12671/jkfs.2014.27.2.173

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Current Concepts in Management of Pilon Fracture

Fig. 1 Mechanism of the axial load type injury. The ultimate fracture pattern depends on the direction and rate of application of the injury force, and on the position of the foot at the time of loading.

Fig. 2 (A) The patient has a pilon fracture with severe soft tissue swelling and blisters. (B, C) A temporary external fixator was applied in order to maintain the length and alignment of the lower leg and reduce the fracture.

Fig. 3 (A) The surgical incision of the anteromedial approach to metaphysis and the ankle joint has been marked out on the patient's left ankle. (B) Deep surgical exposure of the ankle joint using an anteromedial approach. (C, D) Immediate postoperative radiographs show a satisfactory articular reduction and restoration of distal tibial alignment by semi-tubular plate (Synthes®).

Fig. 4 (A, B) Injury anteroposterior and lateral radiographs of a displaced left tibial pilon fracture. (C) Large Volkmann fragment and Chaput fragment were observed. (D, E) Restoration of tibial length and joint spanning by temporary tibia external fixator. (F) Chaput fragment remained attached to the lateral malleolus; however, it was not reduced after reduction and plating of the associated fibular fracture. (G-J) Definitive open reduction and internal fixation was performed using an anterolateral surgical exposure and additional medial plating using the minimally invasive percutaneous osteosynthesis technique after resolution of soft tissue swelling.

Fig. 5 (A) Surgical incision of the posterolateral approach and posterolateral fibular plating was performed. (B) Volkmann fragment was observed after retraction of the peroneal tendon and buttress plating was possible. (C, D) Postoperative radiographs show a satisfactory articular reduction and restoration of distal tibial alignment.

Fig. 6 C3 pilon fracture with a medial open wound sustained by a male of 46 years (smoking history) as a result of a traffic accident. (A, B) Preoperative anteroposterior and lateral radiography. (C) Type II open wound at the medial aspect of the anterior tibia. (D, E) A temporary external fixator was applied in order to maintain the length and alignment of the lower leg and reduce the fracture. (F, G) Immediate postoperative radiographs show a satisfactory articular reduction and restoration of distal tibial alignment by locking the compression plate (Synthes®) in the second stage operation. (H-K) Bone union and satisfactory function of the ankle six months after the operation.

Fig. 7 (A) Initial photo of a pilon fracture with an open wound measuring 4 cm in size. (B) Photo of wound dehiscence three weeks after the initial injury. (C, D) It was treated with reverse sural artery flap.

Fig. 8 (A, B) Posttraumatic arthritis was developed by a pilon fracture. (C, D) Postoperative radiographs treated with total ankle arthroplasty.

Fig. 1

Fig. 2

Fig. 3

Fig. 4

Fig. 5

Fig. 6

Fig. 7

Fig. 8

Current Concepts in Management of Pilon Fracture

Table 1

Comparison of Features between Rotational Injury and Axial Loading Injury

Table 1 Comparison of Features between Rotational Injury and Axial Loading Injury