Fractures of the Distal Tibial Metaphysis Involving the Ankle Joint: The Pilon Fracture

Objectives: We aimed to explore the correlation between the postoperative morphologic changes of ankle mortise and ankle joint function after Ruedi-Allgower type III pilon fracture. Methods: A retrospective analysis was performed for 60 patients with Ruedi-Allgower type III pilon fractures receiving surgical treatment. The height, width, depth, coronal angle, and sagittal angle of ankle mortise were measured based on X-ray films during the last follow-up. The ankle joint function on the injured side was scored according to the Mazur ankle grading scale, and the patients were divided into an excellent group (n = 41), a good group (n = 12), and a mediocre + poor group (n = 7). Results: The correlation between the morphologic changes of ankle mortise and function was analyzed by comparing the five indices of ankle mortise on injured and healthy sides. The injured and healthy sides had significantly different widths, depths, and coronal and sagittal angles of ankle mortise. The differences between the indices of ankle mortise on injured and healthy sides, except for that between heights, were negatively correlated with scores. The differences increased with decreasing score. Effective treatment of the width and depth, together with coronal and sagittal angles of ankle mortise, was significantly correlated with postoperative ankle joint function. Conclusions: Anatomical reduction for the width, depth, and coronal and sagittal angles of ankle mortise of patients with Ruedi-Allgower type III pilon fractures exerts significant positive effects on ankle joint function. Thus, the anatomical form of ankle mortise should be restored as much as possible during surgery.

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Research on Correlation Between Morphological Changes in Ankle Mortise and Ankle Joint Functions After a Pilon Fracture Surgery

Journal of Surgery ◽

10.11648/j.js.20160403.11 ◽

2016 ◽

Vol 4 (3) ◽

pp. 65

Author(s):

Jinshan Wang

Keyword(s):

Ankle Joint ◽

Morphological Changes ◽

Pilon Fracture ◽

Fracture Surgery

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Analysis of bone transport for ankle arthrodesis as a limb salvage procedure for the treatment of septic pilon fracture nonunion

Scientific Reports ◽

10.1038/s41598-021-04187-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Thomas Rosteius ◽

Sebastian Lotzien ◽

Matthias Königshausen ◽

Valentin Rausch ◽

Charlotte Cibura ◽

...

Keyword(s):

Soft Tissue ◽

Limb Salvage ◽

Ankle Joint ◽

Functional Results ◽

Ankle Arthrodesis ◽

Bone Transport ◽

Functional Score ◽

Salvage Procedure ◽

Pilon Fracture ◽

Additional Surgery

AbstractSeptic nonunion of the pilon region with ankle joint infection is challenging for orthopedic surgeons to treat and is associated with a high risk of limb loss. Therefore, the aim of this study was to evaluate the effectiveness of bone transport for ankle arthrodesis in salvaging the limp after septic ankle destruction of the pilon region. We conducted a single-center, retrospective study including 21 patients treated for septic pilon nonunion with accompanying septic ankle destruction via Ilizarov bone transport between 2004 and 2018. In all cases, the complete excision of the nonunion and the resection of the ankle joint were carried out, followed by treating the bone and joint defect with a bone transport into the ankle arthrodesis. In 12/21 patients an additional flap transfer was required due to an accompanying soft tissue lesion. The overall healing and failure rate, final alignment and complications were recorded by the patients’ medical files. The bone-related and functional results were evaluated according to the Association for the Study and Application of Methods of Ilizarov (ASAMI) scoring system and a modified American Orthopedic Foot and Ankle Society (AOFAS) scale. After a mean follow-up of 30.9 ± 15.7 months (range 12–63 months), complete bone and soft tissue healing occurred in 18/21 patients (85.7%). The patients had excellent (5), good (7), fair (4), and poor (3) results based on the ASAMI functional score. Regarding bone stock, 6 patients had excellent, 7 good, and 6 fair results. The modified AOFAS score reached 60.6 ± 18 points (range, 29–86). In total, 33 minor complications and 28 major complications occurred during the study period. In 2 cases, a proximal lower leg amputation was performed due to a persistent infection and free flap necrosis with a large soft tissue defect, whereas in one case, persistent nonunion on the docking side was treated with a carbon orthosis because the patient refused to undergo an additional surgery. Bone transport for ankle arthrodesis offers the possibility of limb salvage after septic ankle destruction of the pilon region, with acceptable bony and functional results. However, a high number of complications and surgical revisions are associated with the treatment of this severe complication after pilon fracture.

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Comparison between buttress plate and anteroposterior screw internal fixation for posterior pilon fracture: a retrospective study

10.21203/rs.3.rs-18058/v2 ◽

2020 ◽

Author(s):

linyuan zhang ◽

zhiqing liu ◽

yueting wang ◽

chao yu ◽

jian tang ◽

...

Keyword(s):

Surgical Treatment ◽

Internal Fixation ◽

Ankle Joint ◽

Joint Pain ◽

Healing Time ◽

Pilon Fracture ◽

Significant Difference ◽

Vas Scores ◽

Buttress Plate

Abstract Background: Posterior pilon fracture (PPF) is a serious ankle injury caused by combined vertical and rotational trauma. Surgical treatment includes buttress plate (BP), anteroposterior screw (APS) and posteroanterior screw (PAS) fixation. This study aimed to compare the therapeutic effects after PPF internal fixation with BPs and APSs. Methods: From January 2015 to June 2018, 37 patients with PPFs underwent surgical treatment in our institution. The patients were divided into the BP (11 patients) and APS (26 patients) groups according to the internal fixation method. Bone healing time and postoperative complications were recorded. At the last follow-up, American Orthopedic Foot and Ankle Society (AOFAS) scores, visual analog scale (VAS) scores and Burwell-Charnley scores were used to evaluate ankle joint function, ankle joint pain, and fracture reduction on imaging, respectively. Results: No significant difference in bone healing time was found between the two groups (P > 0.05). Local necrosis of the posterolateral incision and chronic ankle pain occurred in 1 case each in the BP group. Chronic ankle joint pain occurred in 4 cases in the APS group. Two cases of soft tissue irritation were caused by screws that were too long. Local numbness of the posterolateral incision occurred in 1 case. At the last follow-up, no significant difference in VAS scores between the two groups at rest (P = 0.477), but a significant difference during exercise was noted (P = 0.033). AOFAS scores were better in the BP group than those in the APS group (P = 0.002). According to the Burwell-Charnley scoring system, 11 cases were anatomically reduced in the BP group. In the APS group, anatomical reduction was achieved in 19 cases and fair in 7 cases. Conclusion: Compared with APSs, BPs resulted in better reduction, ankle joint functional recovery and complication rates. BPs are recommended for internal fixation of PPFs.

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Treatment of AO/OTA Type C Pilon Fractures Through the Anterolateral Approach Combined With the Medial MIPO Technique

Foot & Ankle International ◽

10.1177/1071100717746628 ◽

2018 ◽

Vol 39 (4) ◽

pp. 426-432 ◽

Cited By ~ 3

Author(s):

Gi Beom Kim ◽

Oog-Jin Shon ◽

Chul Hyun Park

Keyword(s):

Ankle Joint ◽

Case Series ◽

Anterolateral Approach ◽

Minimally Invasive Plate Osteosynthesis ◽

Pilon Fracture ◽

Fibular Fracture ◽

Additional Surgery ◽

Type C ◽

Pilon Fractures

Background: The purpose of this study was to evaluate the clinical and radiographic results of the treatment of AO/OTA type C pilon fracture via the anterolateral approach using a low-profile plate combined with medial minimally invasive plate osteosynthesis (MIPO). Methods: We retrospectively reviewed 28 ankles with AO/OTA type C pilon fractures that were treated using the anterolateral approach combined with medial MIPO. Mean age was 46 years (range, 19 to 75), and the mean follow-up period was 25 months (range, 14 to 50). Clinical results were assessed using the visual analogue scale (VAS) and the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale. Range of motion (ROM) of the ankle joint was measured, and postoperative complications were investigated via chart review. Results: The VAS and AOFAS Ankle-Hindfoot Scale were 2 and 89, respectively, at the last follow-up. Ankle ROM at the last follow-up was 13 degrees (range, 5 to 20) in dorsiflexion and 38 degrees (range, 35 to 40) in plantarflexion. All the fractures united without additional surgery. One patient (3.6%) had a deep infection at the fibular fracture site, and 1 patient (3.6%) had partial skin necrosis. Conclusion: This combined technique for AO/OTA type C pilon fracture resulted in good ROM of the ankle joint with reasonable function with a fairly low wound complication rate. However, further research on defined indications with a comparison group from multiple centers is necessary to determine if this technique is better than alternative surgical approaches. Level of Evidence: Level IV, case series.

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Simultaneous traumatic dislocation of the hip knee and ankle joints in an ipsilateral limb, does it happen? A case report

International Surgery Journal ◽

10.18203/2349-2902.isj20182793 ◽

2018 ◽

Vol 5 (7) ◽

pp. 2660

Author(s):

Lokesh Kumar S. N. ◽

Deepak Kumar ◽

Sameer Aggarwal

Keyword(s):

Ankle Joint ◽

Hip Joint ◽

Weight Bearing ◽

Posterior Dislocation ◽

Fracture Dislocation ◽

Radiographic Examination ◽

Medial Malleolus ◽

Pilon Fracture ◽

Medial Malleolus Fracture ◽

Dislocation Of The Hip

Simultaneous dislocation of three joints the hip knee and ankle joint in an ipsilateral limb is a very rare pattern of injury and only a single case has been reported in the literature, but it is associated with acetabulum fracture. A 34-year-old male had met with a road traffic accident involving left lower limb. Radiographic examination revealed (i) Posterior dislocation of the hip joint without any fracture (ii) Posterior dislocation of the knee joint(iii)Open fracture dislocation of the ankle joint with medial malleolus fracture tibial pilon fracture. The patient underwent an immediate closed reduction of the hip joint by Allis method. Simultaneous reduction of the knee and ankle joint was done and appropriate splintage gave. Open wounds were well debrided and trans-articular fixator was placed over knee and ankle joint. At a second stage, the medial malleolus fracture and tibia pilon fracture were fixed. MRI scan was done which revealed an anterior cruciate ligament injury of the knee. At 6-month follow-up, the patient was ambulating with full weight-bearing on both lower extremities without any assistive devices. There always lies a high risk of hemodynamic instability and other serious and life-threatening injuries due to the high velocity of trauma involved in such cases. The outcome of ipsilateral hip knee and ankle dislocation can vary widely depending on the circumstances and other associated injuries.

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