Posterior pilon fracture: Epidemiology and surgical technique

Chaparro, Felipe; Ahumada, Ximena; Urbina, C.; Lagos, Leonardo; Vargas, Fernando; Pellegrini, Manuel J.; Barahona, Maximiliano; Bastías, Christian

doi:10.1016/j.injury.2019.10.007

Cited by 23 publications

(9 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It should be noted that the cases in the current study included both classical pilon fractures (AO/OTA 43-B and 43-C) and special ankle fractures (AO/OTA 44-C), although strictly speaking, it might not be appropriate to discuss the fractures as a whole. Sometimes ankle fractures involving the distal tibial plafond are caused by a combined injury mechanism, which typically leads to a confusing classi cation of the fracture, such as a "logspatter" injury [16] versus an atypical pilon fracture, as well as a posterior malleolus fracture versus a "posterior pilon" fracture [17]. We would like to use the words "fractures involving the distal tibial plafond" rather than "tibia pilon fractures" to describe the confusing ankle fractures in the present study.…”

Section: Discussionmentioning

confidence: 99%

A Fibular Notch Approach for the Treatment of Ankle Fractures Involving the Distal Tibial Plafond

Liu

Cheng

2021

Preprint

View full text Add to dashboard Cite

BACKGROUND: Although efficacy is related to many factors, the surgical approach is one of the most important intervention factors for complex ankle fractures. Ankle fractures involving the distal tibial plafond frequently present a surgical challenge in choosing which incisions will be best for surgical treatment. Here we present an innovative fibular notch approach for the treatment of some specific ankle fractures and present a series of patients with either functional or radiographic outcomes.METHODS: Twenty two patients with distal tibial plafond fractures with concomitant fibular and distal tibiofibular syndesmosis injuries were treated through a fibular notch approach in this retrospective study. The details of the surgical technique were reviewed from the operative notes. Relevant data were reviewed from the medical records. The quality of fractures and syndesmosis reduction was examined using CT scans, and lateral stability of the ankle was assessed by physical examination and stress radiographs. The American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS) score was implemented for clinical functional assessment.RESULTS: All surgeries were successfully performed via the fibular notch approach as the primary approach with excellent intraoperative visualization. Postoperative radiography revealed satisfying restoration of all fractures and syndesmosis. All fractures healed with an average time of 17.3±3.6 weeks. Mild posttraumatic osteoarthritis (PTOA) was present in 4 patients. The average AOFAS score was 88.8 at the last followup.CONCLUSIONS: The fibular notch approach is a safe and reliable approach for the treatment of specific ankle fractures involving the distal tibial plafond. This approach provides excellent direct visualization of the fragments and articular surface without significantly increasing iatrogenic injuries. Satisfactory radiographic and clinical results were observed, and further clinical and anatomical studies are recommended to ascertain the feasibility of this approach in the treatment of complex distal tibial fractures.

show abstract

Section: Discussionmentioning

confidence: 99%

A Fibular Notch Approach for the Treatment of Ankle Fractures Involving the Distal Tibial Plafond

Liu

Cheng

2021

Preprint

View full text Add to dashboard Cite

show abstract

“…It should be noted that the cases in the current study included both classical pilon fractures (AO/OTA 43-B and 43-C) and special ankle fractures (AO/OTA 44-C), although strictly speaking, it might not be appropriate to discuss the fractures as a whole. Sometimes ankle fractures involving the distal tibial plafond are caused by a combined injury mechanism, which typically leads to a confusing classi cation of the fracture, such as a "logspatter" injury [16] versus an atypical pilon fracture, as well as a posterior malleolus versus a "posterior pilon" fracture [17]. We would like to use the words "fractures involving the distal tibial plafond" rather than "tibia pilon fractures" to describe the confusing ankle fractures in the present study.…”

Section: Discussionmentioning

confidence: 99%

A Fibular Notch Approach for the Treatment of Ankle Fractures Involving the Distal Tibial Plafond

Liu

Cheng

2020

Preprint

View full text Add to dashboard Cite

BACKGROUND: Although several approaches have been used for the treatment of complex ankle fractures, there are still some ankle fractures which can not obtain ideal intraoperative exposure with these traditional approaches. The purpose of this study was to present an innovative fibular notch approach in detail for the treatment of ankle fractures involving the distal tibial plafond and to present a series of patients with either functional or radiographic outcomes.METHODS: Between March 2015 and October 2018, 22 patients with distal tibial plafond fractures with concomitant fibular and distal tibiofibular syndesmosis injuries were treated through a fibular notch approach. The details of the surgical technique were reviewed from the operative notes. Relevant data were reviewed from the medical records. The quality of fractures and syndesmosis reduction was examined using CT scans, and lateral stability of the ankle was assessed by physical examination and stress radiographs. The American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS) score was implemented for clinical functional assessment.RESULTS: All surgeries were successfully performed via the fibular notch approach as the primary approach. Postoperative radiography revealed satisfying restoration of all fractures and syndesmosis; however, CT scans showed mild malreduction with a gap of less than 2 mm in 4 fractures and a step-off of less than 2 mm in 1 fracture. No significant soft tissue complications occurred except for one case of delayed wound healing. All fractures healed with an average time of 17.3±3.6 weeks. Mild posttraumatic osteoarthritis (PTOA) was present in 4 patients. All patients achieved lateral stability of the ankle except one patient with distal syndesmosis instability. The average ankle range of motion was 55.0 degrees. The average AOFAS score was 88.8.CONCLUSIONS: The fibular notch approach is a safe and reliable approach for the treatment of specific ankle fractures involving the distal tibial plafond. This approach provides excellent direct visualization of the fragments and articular surface without significantly increasing iatrogenic injuries. Satisfactory radiographic and clinical results were observed, and further clinical and anatomical studies are recommended to ascertain the feasibility of this approach in the treatment of complex distal tibial fractures.

show abstract

“…All cases of posterior pilon fracture treated by surgical reduction through the extended modified posteromedial approach or posterolateral approach in combination with fixation with a buttress plate at the Department of Orthopedic Trauma of Jining Medical College between January 2015 and December 2018 were reviewed. Patients aged ≥ 18 years, with good ankle movement prior to injury, and a new closed fracture corresponding to the imaging characteristics of posterior pilon fracture [7] (distal tibial fracture line extending along the coronal plane into the posterior colliculus or even the anterior colliculus, with or without the "double contour sign" of the proximal medial malleolus, the posterior malleolus displaced proximally, and the margin of the bone mass compressed and fragmented; Die-punch bone masses, with or without subluxation of the posterior talus, were also present) were included. Patients with pathological fractures, associated neurovascular injuries, a history of ankle disease or serious trauma prior to injury, and a follow-up < 12 months were excluded.…”

Section: Study Populationmentioning

confidence: 99%

Clinical efficacy of extended modified posteromedial approach versus posterolateral approach for surgical treatment of posterior pilon fracture: a retrospective analysis

Zhang

Wang

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Posterior pilon fracture is a type of ankle fracture associated with poorer treatment results compared to the conventional ankle fracture. This is partly related to the lack of consensus on the classification, approach selection, and internal fixation method for this type of fracture. This study aimed to investigate the clinical efficacy of posterolateral approach versus extended modified posteromedial approach for surgical treatment of posterior pilon fracture. Methods: Data of 67 patients with posterior pilon fracture who received fixation with a buttress plate between January 2015 and December 2018 were retrospectively reviewed. Patients received steel plate fixation through either the posterolateral approach (n = 35, group A) or the extended modified posteromedial approach (n = 32, group B). Operation time, intraoperative blood loss, excellent and good rate of reduction, fracture healing time, American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale score, and Visual Analogue Scale score were compared between groups A and B. Results: All patients were followed up for an average period of 15.4 months. No nonunion, failure of internal fixation, or anklebone stiffness occurred in either group during the follow-up period. However, the operation time was significantly shorter, intraoperative blood loss was significantly lower, AOFAS Ankle-Hindfoot Scale score was significantly higher, and Visual Analogue Scale score was significantly lower in group B than in group A (P < 0.05). Conclusion: Compared to the posterolateral approach, the extended modified posteromedial approach can provide a better surgical field for the treatment of posterior pilon fracture, which allows reduction and fixation of this type of fractures under direct vision and evaluation of reduction effects, and reduces operation time and intraoperative blood loss. Combining this approach with supporting steel plate fixation enables early functional rehabilitation of the ankle with more satisfactory clinical results.

show abstract

Posterior pilon fracture: Epidemiology and surgical technique

Cited by 23 publications

References 27 publications

A Fibular Notch Approach for the Treatment of Ankle Fractures Involving the Distal Tibial Plafond

A Fibular Notch Approach for the Treatment of Ankle Fractures Involving the Distal Tibial Plafond

A Fibular Notch Approach for the Treatment of Ankle Fractures Involving the Distal Tibial Plafond

Clinical efficacy of extended modified posteromedial approach versus posterolateral approach for surgical treatment of posterior pilon fracture: a retrospective analysis

Contact Info

Product

Resources

About