![]() Thordarson DB, complications of tibial pilon fx: prevention and management strategies/ JAAOS 2000 8:253.Leone VJ, Ruland RT, Meinhard BP: The management of the soft tissues in pilon fractures.Tsherne H, Gotzen L: Fractures with Soft Tissue Injuries.Gustilo RB, Anderson JT: Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones.A staged protocol for soft tissue management in the treatment of complex pilon fractures. Sirkin M, Sanders R, DiPasquale T, Herscovici D Jr.Two-staged delayed open reduction and internal fixation of severe pilon fractures. Watson JT, Tibial Pilon Fractues, Techniques in Orthopaedics, 11:150-159, 1996.Watson JT, Pilon Fractures, Clin Orthop, 375:78-90, 2000.Marsh JL, Borrelli J Jr, Dirschl DR, Sirkin MS.external fixation = early ROM exercises, WB advanced at 6wks, FWB before removal, dynamize 1-2 wks before removal.nonweightbearing at least 6wks generally 12 weeks., Ankle and subtalar ROM exercises.3-9% eventually require arthrodesis due to secondary arthrosis.1/3 associated with concomitant fx or organ injuries.Pilon Fracture Associated Injuries / Differential Diagnosis Tsherne 2 & 3 and open fx best treated with limited open fixation(olive wires/canulated screws) for articular reduction and small wire circular external fixation.Tscherne grades 0 or 1 best treated with AO/ASIF technique plating, femoral distractor often helpful for indirect reduction. Reudi-Allgower Classification: Type I & II = 86% excellent to good results nonuniomn =7%, malunion=3%, wound dehiscence=17% Type II&III high energy=wound problems and deep infection uto 37%, malunion=23%, nonunion=27%.poor results associated with high-grade soft-tissue injury, >2mm articular incongruency, malalignment of mechanical axis >5degrees.Type good/excellent results, Type B=partial good/excellent results, Type C=complete good/excellent results.Ruedi Allgower Classification (Ruedi TP, Allgower M CORR 1979 138:105).AO comprehensive Classification of Fractures of long Bones.(one 6mm centrally threaded calcaneal pin and one proximal tibia pin at level of the fibular head with quadrilateral frame.) Open fractures/compartment syndromes should be taken to OR for external fixation / fasciotomy.Closed fractures may be placed in calcaneal traction and a Bohler-Braun frame.CT scan should be performed in traction for pre-op planning. Treatment: initial fixation of the fibula with temporary spanning external fixation with delayed conversion to internal fixation when soft tissues permit, generally 14-21 days.Principles of Treatment: restoration of fibular length, anatomic reduction of tibial articular surface, bone grafting of metaphyseal defects, medial buttress plating to prevent varus. ![]() Open fracture classified per Gustilo and Anderson.Soft tissues injuries are classified according to Tscherne and Gotzen.CT scan indicated for pre-op planning, CT scans should be done in traction with 3D reconstructions.A/P, lateral and mortise views of the ankle A/P, lateral tibia films.Assess vascularity by evaluating dorsalis pedis and posterior tibial pulses as well as distal capillary refill.Distal tibia fractures within 5cm of the ankle.Foot postion determines fracture pattern: if plantar flexed = posterior tibial fragment, neutral = entire articular surface, dorsiflexed=anterior fragments.Usually high energy axial load (MVC, fall from height), occasionally low-energy rotation/torsion.Pilon fractures are fractures involving the articular weight bearing surface of the distal tibia.Pilon Fracture Etiology / Epidemiology / Natural History 823.92 (Unspecified part, open, fibula with tibia).823.91(open fracture of unspecified part fibula alone).823.90(open fracture of unspecified part of tibia).823.82 (closed fracture lower leg NOS fibula with tibia).823.81(closed fracture lower leg NOS fibula alone).823.80(closed fracture of unspecified part of tibia).S82.876 Nond isplaced pilon fracture of unspecified tibia.S82.875 Nondisplaced pilon fracture of left tibia.S82.874 Nondisplaced pilon fracture of right tibia.S82.873 Displaced pilon fracture of unspecified tibia.S82.872 Displaced pilon fracture of left tibia.S82.871 Dis placed pilon fracture of right tibia.Synonyms: Tibial Plafond Fracture, pilon fracture, weight bearing surface of distal tibia fracture Classification / Treatment / ORIF / Ex FixĪssociated Injuries / Differential Diagnosis
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |