Secondary below-knee amputation following open reduction and internal fixation of a closed pilon fracture

Abstract

Rationale: Despite significant advances in surgical techniques and implants, the clinical outcome of high-energy pilon fractures remains unsatisfactory, which continues to represent numerous challenges for orthopedic trauma surgeons. Patient concerns: A 62-year-old man injured his right ankle after falling from a 3 m high place. There were no open wounds or other complications. Diagnoses: According to the X-ray and CT scans, the patient was diagnosed with pilon fracture (type AO-43-C2) and lateral malleolus fracture of the right limb. Interventions: The patient was initially treated with calcaneal traction upon admission to a primary hospital. Five days after the injury, the patient underwent open reduction and internal fixation (ORIF) of the fracture and vacuum sealing drainage (VSD) for wound closure. Outcomes: The patient presented to our hospital on the 9th day after the first ORIF operation because of critical ischemia of the affected foot and distal lower leg. Blood circulation did not improve after a series of salvage treatments, and below-knee amputation was ultimately performed. Lessons: This is a rare case of complete ischemic necrosis following ORIF surgery of a closed pilon fracture due to iatrogenic damage. Standardized treatment that strictly follows the guidelines, instructions, or expert consensus should be promoted in this kind of complicated pilon fracture.

Anterior Tibial to Dorsalis Pedis Bypass to Manage Acute Ischemia Attributed to Pilon Fracture

“…These confirm the surgical challenge and complexity of the tibial/pilon fractures and underscore the high suspicion of vascular injury that the physician should have, since the ischemia time affects significantly the successful salvage while some vascular injuries can go undetected in closed pilon fractures leading to irreversible damage. 8,9…”

“…These confirm the surgical challenge and complexity of the tibial/ pilon fractures and underscore the high suspicion of vascular injury that the physician should have, since the ischemia time affects significantly the successful salvage while some vascular injuries can go undetected in closed pilon fractures leading to irreversible damage. 8,9 Autogenous greater saphenous vein is the graft material of choice for bypass operations, especially when it comes to vessels below the knee as inflow or outflow vessels. Ideally, the diameter mismatch between the reversed vein and the target artery should be minimal to avoid flow disturbances and facilitate long-term patency.…”