scholarly journals Management of Pilon Fractures—Current Concepts

2021 ◽  
Vol 8 ◽  
Author(s):  
Olivia Mair ◽  
Patrick Pflüger ◽  
Kai Hoffeld ◽  
Karl F. Braun ◽  
Chlodwig Kirchhoff ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Distal Tibia ◽  
High Energy ◽  
Classification Systems ◽  
Early Years ◽  
Long Term Outcome ◽  
Soft Tissue Envelope ◽  
Tibial Pilon ◽  
Axial Forces ◽  
Pilon Fractures

Tibial pilon fractures were first described by Étienne Destot in 1911. He used the French word “pilon” (i.e., pestle), to describe the mechanical function of the distal tibia in the ankle joint. This term has further been used to portray the mechanism involved in tibial pilon fractures in which the distal tibia acts as a pestle with heavy axial forces over the talus basically causing the tibia to burst. Many different classification systems exist so far, with the AO Classification being the most commonly used classification in the clinical setting. Especially Type C fractures are extremely difficult to manage as the high energy involved in developing this type of injury frequently damages the soft tissue surrounding the fracture zone severely. Therefore, long -term outcome is often poor and correct initial management crucial. In the early years of this century treatment has evolved to a two–staged protocol, which nowadays is the gold standard of care. Additional methods of treating the soft tissue envelope are currently being investigated and have shown promising results for the future. The aim of this review is therefore to summarize protocols in managing these difficult fractures, review the literature on recent developments and therefore give surgeons a better understanding and ability to handle tibial pilon fractures.

High-energy tibial pilon fractures: an instructional review

2019 ◽  
Vol 43 (8) ◽  
pp. 1939-1950 ◽  
Author(s):  
Boris A. Zelle ◽  
Khang H. Dang ◽  
Samuel S. Ornell
Keyword(s):  
High Energy ◽  
Tibial Pilon ◽  
Pilon Fractures

scholarly journals Open Reduction Internal Fixation versus External Fixation with Limited Internal Fixation for Displaced Comminuted Closed Pilon Fractures: A Randomised Prospective Study

2018 ◽  
Vol 24 (1) ◽  
pp. 84-89
Author(s):  
Rayan Ahmed ◽  
Kotb Ahmed ◽  
M. Elmoatasem Elhussein ◽  
Samir Shady ◽  
Tamer A. El-Sobky ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Prospective Study ◽  
Internal Fixation ◽  
External Fixation ◽  
Functional Outcomes ◽  
Open Reduction ◽  
Articular Surface ◽  
High Energy ◽  
Complication Rates ◽  
Pilon Fractures

Background Pilon fractures involve the dome of the distal tibial articular surface. The optimal treatment for high-energy pilon fractures remains controversial. Some authors advocate the use of open reduction and internal fixation (ORIF) to avoid articular incongruence. Others advocate the use of bridging external fixation with limited internal fixation (EFLIF) to reduce soft tissue complications. Literature reports of prospective studies comparing the radioclinical outcomes of ORIF and EFLIF in high-energy fractures are scarce. Retrospective studies have their limitations because of insufficient randomisation. The objective of this randomised prospective study is to compare the clinical, radiologic and functional outcomes of displaced and comminuted closed pilon fractures, Rüedi and Allgöwer type II and III, treated by either ORIF or EFLIF. Materials and Methods Forty-two patients were selected for the study. Twenty-two patients were subjected to ORIF and 20 patients were subjected to EFLIF. We used the American Orthopaedic Foot and Ankle Society score as a standard method of reporting clinical status of the ankle. Patients were followed-up clinically and radiologically for over 2 years after the surgical treatment. Results The results of ORIF and EFLIF in treatment of high-energy pilon fractures are equally effective in terms of functional outcomes and complication rates on the short term. Conclusion Soft tissue integrity and fracture comminution seem to have a significant influence on outcomes of intervention. A prospective multicentre study with a larger sample size that controls for other associated variables and comorbidities is warranted. Level of evidence Level II.

Tibial plafond fractures

2011 ◽  
Author(s):  
J.L. Marsh
Keyword(s):  
Soft Tissue ◽  
Soft Tissues ◽  
Preoperative Planning ◽  
Distal Tibia ◽  
Soft Tissue Envelope ◽  
Tibial Plafond ◽  
Tibial Plafond Fractures

♦ Tibial plafond fractures demand respect, largely due to the fragile soft tissue envelope that surrounds the distal tibia♦ Careful preoperative planning followed by meticulous operative handling of the soft tissues is required to avoid devastating complications.

scholarly journals Intra- and interobserver agreement on the Oestern and Tscherne classification of soft tissue injury in periarticular lower-limb closed fractures

2014 ◽  
pp. 173-178 ◽  
Author(s):  
Carlos Oliver Valderrama-Molina ◽  
Mauricio Estrada-Castrillón ◽  
Jorge Andres Hincapie ◽  
Luz Helena Lugo-Agudelo
Keyword(s):  
Soft Tissue ◽  
Tibial Plateau ◽  
Interobserver Agreement ◽  
Soft Tissues ◽  
Tissue Injury ◽  
Soft Tissue Injury ◽  
Case Series ◽  
Lower Extremities ◽  
Tibial Pilon ◽  
Pilon Fractures

Background: The soft tissues injury in periarticular fractures of the lower extremities determines the proper time to perform bone fixation. Objetive: The aim of this study was to determine the intra and interobserver agreement in the Tscherne classification. Methods: This is a descriptive, prospective study for patients admitted to the Pablo Tobón Uribe Hospital (PTUH) with tibial plateau or tibial pilon fractures. We performed a standardize evaluation using video photography at the time of admission and 24, 48, and 72 h after admission. Fifteen five reviewers who had various levels of training produced a total of 1,200 observations. The intra- and interobserver agreement was assessed using a weighted kappa for multiple raters and more than two categories. Results: Twenty patients were admitted with tibial plateau and tibial pilon fractures. The intraobserver agreement for all 15 raters was kappa 0.81 (95% CI 0.79-0.83), and the interobserver agreement for all 15 raters was kappa 0.65 (95% CI 0.55-0.73). The interobserver agreement at 24 h was kappa 0.67 (95% CI 0.46-0.86). Conclusions:Classifying the severity of soft tissue injury is critical in planning the surgical management of fractures of the lower extremities. Based on our results, we can reasonably argue that the Tscherne classification produced an adequate level of agreement and could be used to standardize and to guide the treatment, and to conduct research studies. Level of Evidence: Level IV, Case Series

A Operative Treatment of the Tibial Pilon Fractures : For minimize soft tissue injury

1997 ◽  
Vol 10 (2) ◽  
pp. 346
Author(s):  
Jae Do Kang ◽  
Kwang Yul Kim ◽  
Hyung Chun Kim ◽  
Moon Sub Yim ◽  
Sang Hoon Ko
Keyword(s):  
Soft Tissue ◽  
Operative Treatment ◽  
Tissue Injury ◽  
Soft Tissue Injury ◽  
Tibial Pilon ◽  
Pilon Fractures

scholarly journals Result of Ring Fixator in High-energy Schatzker Type VI Fractures of Proximal Tibia

2021 ◽  
pp. 451-459
Author(s):  
Aftab Alam Khanzada ◽  
Muhammad Rafique Joyo ◽  
Muhammad Imran Javed ◽  
Nizam Ahmed ◽  
Niaz Hussain Keerio ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Tissue Damage ◽  
Proximal Tibia ◽  
High Energy ◽  
Soft Tissue Damage ◽  
Soft Tissue Envelope ◽  
Ring Fixator ◽  
Schatzker Type ◽  
Tibia Fractures ◽  
Proximal Tibia Fractures

Background: Significant articular depression, separation of both condyles, diaphyseal comminution and dissociation, and loss of soft-tissue envelope integrity are all associated with high-energy proximal tibia fractures (Schatzker VI). Over the past 50 years, there has been a lot of research on plating problems in these complicated fractures. For the care of these complex injuries, Ilizarov devised a new method (ring fixator). Aim of the Study: To examine the outcomes of patients who received a ring fixator for the treatment of high-energy proximal tibia fractures (Schatzker VI). Materials and Methods: Fourteen patients (mean age 36) were treated with the Ilizarov fixator and transfixion wires for high-energy fractures of the proximal tibia (Schatzker VI). Nine of the patients had open fractures, and five of them had significant soft tissue damage. They were all tracked for an average of 19.4 months. The result was analyzed using the criteria set by Honkonen & Jarvinen (1992). Results: Thirteen fractures healed in an average of 14.6 weeks, with one taking six months. Twelve patients recovered complete extension, while eight others regained more than 110 degrees of flexion. All of the patients knees were stable, except one who had a minor varus deformity. Nine patients walked normally, while four had a little limp. Except for one, all of the knees exhibited an articular step-off of less than 4 mm and normal axial alignment. Six knees were found to be outstanding, five to be decent, and three to be fair. There were no instances of postoperative skin infection or septic arthritis, however, three patients did have a pin tract infection that was effectively managed. Conclusion: The technique is suitable for the treatment of complex proximal tibia fractures when there is substantial comminution at the fracture site as well as soft tissue damage (Schatzker VI).

Is Obesity Protective Against Wound Healing Complications in Pilon Surgery? Soft Tissue Envelope and Pilon Fractures in the Obese

Orthopedics ◽  
2010 ◽  
Author(s):  
Matthew L. Graves ◽  
Scott E. Porter ◽  
Bryan C. Fagan ◽  
Glenn A. Brien ◽  
Matthew W. Lewis ◽  
...  
Keyword(s):  
Wound Healing ◽  
Soft Tissue ◽  
Soft Tissue Envelope ◽  
Pilon Fractures

scholarly journals Results of Staged Treatment with External Fixation for High Energy Calcaneus Fractures

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0030
Author(s):  
Jessica M. Kohring ◽  
Mackenzie A. Neumaier ◽  
John P. Ketz
Keyword(s):  
Soft Tissue ◽  
Physical Function ◽  
External Fixation ◽  
High Energy ◽  
Inclusion Criteria ◽  
Soft Tissue Envelope ◽  
Calcaneus Fracture ◽  
Initial Injury ◽  
Staged Treatment ◽  
Calcaneus Fractures

Category: Trauma; Hindfoot Introduction/Purpose: High energy calcaneus fractures have significant soft tissue compromise and typically poor outcomes. The purpose of this study was to describe patient complications and outcomes, after undergoing staged treatment for high energy calcaneus fractures, including initial treatment with medial calcaneal external fixation followed by definitive reconstruction. Methods: A retrospective chart review with prospective data was performed from April 2013 to February 2019. Inclusion criteria for the study included: patients >18 years of age, closed Sanders III and IV fractures or open fractures of the calcaneus. Patients were initially treated with placement of a medial based external fixator with closed reduction. Once the soft tissue envelope had improved, definitive fixation was performed, either ORIF or ORIF with primary subtalar fusion. Results: There were a total of 15 patients that met inclusion criteria for the study. 9 of the fractures were open and 6 were closed. The medial calcaneal external fixation (ex-fix) was placed at a mean of 2.0 (0-12) days after initial injury. The definitive procedure occurred at a mean of 23.6 (12-42) days after ex-fix placement. 11 of the patients underwent calcaneus fracture ORIF with primary subtalar (ST) fusion and 4 patients were treated with calcaneus fracture ORIF alone. 14 (93%) of the patients showed radiographic union at an average of 6.7 months. Mean PROMIS scores showed improvement in physical function, mood, and a decrease in pain at an average of 19 (5-72) months after initial injury. The average VAS pain score was 3.5 (0-7). Conclusion: A staged protocol for high-energy and open calcaneal fractures is an effective tool in treating these difficult injuries. It allows the soft tissues to improve while maintaining length and alignment of the fracture for definitive fixation and minimizing complications. There were improvements in physical function, mood, and a decrease in pain at final follow-up of almost 2 years. [Table: see text]

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