Fractures of the distal tibial metaphysis, with extension into the articular region, or pilon fractures, are commonly due to vertical compression trauma, or, more rarely, to torsional forces which result in a spiral fracture of the distal tibia with extension into the ankle joint. View and download powerpoint presentations on tibial plafond pilon fractures ppt. Preoperative evaluation includes a careful clinical assessment of the. A pilon fracture is a type of fracture involving the distal tibia. Since these injuries affect a high stress area of a. Kaarela2 1department of orthopaedic trauma, oulu university hospital, oulu, finland 2department of plastic surgery, oulu university hospital, oulu, finland c e r a m e n t c a s e o f t h e m o n t h c e r a m e n t c a s e o f t h e m. Pilon is the french word for pestlean instrument used for crushing or pounding.
The timing and type of definitive fixation is dictated by the soft tissue injury and energy imparted to the fracture. External fixation of severely comminuted and open tibial pilon fractures. After recovery from pilon fractures, many patients continue to have debilitating pain and ankle stiffness. These bullet points on pilon fracture recovery are things i have learned in the past year. Three main fracture fragments, medial malleolus, chaput, and volkmann are commonly formed as a result of the fracture lines created in pilon injuries. The anterior tibial artery may be palpated during this step to help with identification and protection of the neurovascular bundle. Cases included illustrate different management strategies for schatzker ivi tibial plateau fractures, plates and screws for proximal tibia fracture, intramedullary nailing for midshaft and distal tibial fracture, and the use of exfix with open tibia and distal pilon fracture, in addition to masquelet bone grafting and modified clamshell. Intraarticular fracture of the distal tibia without significant displacement. Pilon fractures include a wide range of complexity. Despite the fact that the treatment of these fractures. Pilon fracture accounts for 1% of lower extremity fractures and 57% of tibial fractures 1, 2. The acumed ankle plating system 3 is designed to provide a variety of fixation options for fractures of the distal tibia and fibula. Find powerpoint presentations and slides using the power of, find free presentations research about tibial plafond pilon fractures ppt.
In many pilon fractures, the bone may be crushed or split into several pieces due to the highenergy impact that caused the injury. A highenergy trauma motor vehicle injuries, with severe articular and soft tissue lesions, b rotation trauma, skiing accidents, with modest articular and soft tissue damage, and c lowenergy trauma in elderly people. Individuals with a pilon fracture can have the following symptoms. The anterolateral approach to the tibia has been popularized for management of tibial pilon fractures.
Pilon fracture, the most severe form of ankle fracture, the joint surface of the tibia called the tibial plafond is broken and the weight bearing part of the joint surface may then. Commonly, the fibula bone in the ankle is broken as well. Plates have been designed with concern for the thin soft tissues on the tibia and are low profile with 2. Once the fractures are healed, the goals are to restore your ankles movement and strength. Tibial plafond, or pilon, fractures can be some of the most difficult fractures to manage. These can be challenging to manage, especially when associated with significant softtissue injury. Pilon fractures constitute 1% of lower limb fractures and 7% of tibial fractures. Despite the best treatment, patients sustaining highenergy pilon fractures generally do not return to their previous state of general health or function.
These are considered to represent 110% of all lower limb fractures 6. Patients sustaining trauma resulting in a pilon fracture often have rapid and significant soft tissue swelling that can quickly result in large skin blister formation. A pilon fracture typically occurs as the result of a highenergy event, such as a car collision or fall from height. If you get it right the al andor pl tibial fragments will be in the right place. Patients with pilon fractures are liable for developing many complications that result from long period of immobilization as well as from the nature of injury. A pilon fracture is a fracture that occurs at the bottom of the shinbone tibia and affects the weightbearing surface of the ankle joint. A 32yearold man sustains a pilon fracture which is treated initially with a spanning external fixator, as shown in figure a. Pilon fractures are caused by rotational or axial forces, mostly as a result of falls from a height or motor vehicle accidents. Key facts the tibial pilon fracture is a rare, yet devastating injury. Pilon fracture surgery usually is done in two steps to protect the skin and soft tissue. Evolution in management of tibial pilon fractures ncbi. Most of the time, highimpact injury breaks both bones of the lower leg. Pilon fractures are rare, comprising 3 to 10 percent of all fractures of the tibia and 1 percent of. Highenergy tibial pilon fractures continue to represent a significant challenge to the treating orthopaedic surgeon.
Decide on plate placement based on the fracture pattern. Typically occurs as a result of an axial loading injury which drives the talus into the tibial plafond. Pilon fracture what is, recovery, causes, symptoms. Tibial pilon fracture with intact fibula everything you need to know. Tibial plafond fracture orif with anterolateral approach and plate fixation. Pilon fractures in the distal tibia result from axial forces that can range from low to high energy and produce a spectrum of articular and metaphyseal injuries. Pilon is a french word for pestle also known as plafond fracture. It is intraarticular fracture of the distal end of the tibia, involving the disruption of the distal tibial weightbearing articular surface. Tibial pilon fractures are severe injuries to the distal articular surface of the tibia. The goals of pilon fracture surgery are to restore alignment and stability and allow healing of the tibia and fibula at the ankle joint. Distal tibia pilon fractures new york fracture care. Powerpoint templates in most cases, both bones are. Rehabilitation guidelines for tibial plateau fracture 4 p a g e cardiovascular exercises treadmill running, bike, ube progression criteria independent with hep passing score on return to sport test with low risk of reinjury reported. Hi, my name is zach and i have been going through recovery from pilon fracture surgery since march 20th 2015.
If you have suffered a pilon fracture also called a tibial plafond fracture or know someone who has, this can be. Fracture du tibia distal, fracture du pilon tibial, fracture du plafond tibial, osteosynthese par. Arthrex internal fixation for distal tibia fracturepilon. Pilon tibial plafond fractures ruedi and allgower classification classification type i. Complete fractures of the tibial pilon are rare and their treatment difficult. Pilon fracture rehabilitation exercises program outcome. One of the rarest skeletal injuries, less than 10% of lower leg injuries. If you have a pilon fracture, you might have bruising, deformity, swelling, or pain. Fracture fermee sans traumatisme des parties molles. Such injuries frequently result from highenergy axial impact and are often associated with extended soft. Distal tibia pilon fractures a 42yearold male slipped and fell approximately 14 feet while working on a ladder onto his right lower extremity. Frequently adopted is the one proposed by ruedi and allgower 5. Fracture du pilon tibial anatomie et classification clubortho.
Named pilon from the french word for hammer because of the hammerlike way in which the talus drives into the weightbearing surface of the distal tibia, these fractures are uncommon, making up only about 1% of fractures of the lower extremities. A pilon fracture, is a fracture of the distal part of the tibia, involving its articular surface at the ankle joint. Beingessner introduction pilon fractures continue to be challenging injuries due to their associated and often complex osseous and softtissue injury components. One should have a low threshold for staged protocols and delayed definitive fixation. Pilon fracture is a mechanistic term that is commonly applied to injuries of the tibial plafond and describes an. Many pilon fractures occur due to high energy injuries such as motor vehicle accidents, falls from a height, or highvelocity sports injuries such. Alashhab, md p ilon fracture is a severe and challenging to treat distal tibial injury. Distal tibia fracture with intraarticular extension. Pdf tibial pilon fractures are challenging to treat, as they are typically intraarticular and associated with extensive soft tissue damage. The full text of this article is available in pdf format. Fulllength tibia and fibula images further help evaluate possible extension of fracture lines into the tibial shaft, coexisting proximal fractures, or.
Because there is a limited muscle cover between skin and bone at this level of the lower limb, energy derived from injury is transferred directly to these soft tissue structures. We refer to the following article which reports our outcome and experience with the anterolateral approach to the pilon, open reduction and internal fixation of tibial pilon fractures using a lateral approach. The blood supply to the distal leg is provided by branches of the posterior tibial, peroneal, and dorsalis pedis arteries. In many pilon fractures, the bones of the ankle joint are crushed due to the high energy impact causing the injury. The distal tibia plates are made of stainless steel and are an extension of the ankle fracture management system. Orthobullets team % technique video 0 % technique steps 0. When you fall from a high building or tree, you may also experience a pilon fracture. Background distal tibia fracture with intraarticular extension. Having three parts, this is a more unstable fracture and may be associated with ligamentous injury. Six main fragments involved in tibial pilon fracture have been identified 51. The pilon fracture is a comminuted fracture of the distal tibia. Primary ankle arthrodesis for severely comminuted tibial. Aotrauma tibia, distalpilon fracture type 43 c23 duration. As they are often associated with highenergy trauma, both the soft tissue involvement and the comminuted fracture pattern pose challenges to fixation.
He was taken to our emergency department and radiographs revealed a rightsided displaced distal tibial pilon fracture with extensive articular comminution and associated displaced fibula fracture. A pilon fracture is a type of break of the shinbone that happens near the ankle. The fractures involve the medial malleolus, the posterior aspect of the tibial plafond referred to as the posterior malleolus and the lateral malleolus. Tibial pilon fractures are a challenge because of the difficulty of treatment. As they are often associated with highenergy trauma, both.
This type of fracture requires long postoperative rehabilitation time than basic ankle fractures 8. He is now 3 weeks from injury and skin swelling has subsided significantly. You can get a pilon fracture when you are involved in highenergy activities and injuries such as accidents from a motorcycle and skiing accidents. Pilon fractures are complex injuries to the ankle region with disrupt the main weight bearing region of the shinbone tibial part of the ankle. Dermabrasion superficielle ou contusion cutanee liee au deplacement dun.
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