scholarly journals Surgical Treatment Approach for Pilon and Talar Dome Fracture

2020 ◽  
Vol 110 (4) ◽  
Author(s):  
Jin Park ◽  
Hyo Beom Lee ◽  
Gab Lae Kim ◽  
Kyu Hyun Yang
Keyword(s):  
Scientific Literature ◽  
Treatment Approach ◽  
Distal Tibia ◽  
Skin Incision ◽  
Anterolateral Approach ◽  
Pilon Fracture ◽  
Talar Dome ◽  
Plating Technique ◽  
Talar Fractures ◽  
Pilon Fractures

Talar injuries that are associated with pilon fractures include talar body fractures, osteochondral defects, and posterior process talar fractures. Pilon fractures, in combination with talar dome fractures, have not yet been reported in the scientific literature. We report the case of a 15-year-old boy who sustained a pilon fracture with a lateral talar dome fracture. The pilon fracture was initially fixed using a temporary external fixator for soft-tissue care. After the swelling subsided, definitive internal fixation was performed. First, the lateral talar dome fracture was directly reduced and fixed using a small anterolateral approach of the ankle. Then, the intra-articular portion of the pilon fracture was directly reduced using the same anterolateral approach and an additional small anteromedial approach, and the extra-articular metaphyseal portion of the pilon fracture was indirectly reduced. The pilon fracture was finally fixed with an anterolateral distal tibia plate, using a submuscular plating technique through the anterolateral approach and a separate proximal skin incision. A medial distal tibia plate was later added using a subcutaneous plating technique through the anteromedial approach and another proximal skin incision. Both the pilon fracture and the lateral talar dome fracture were addressed simultaneously through a combination of the small anterolateral and anteromedial approaches.

Comparison of Ankle Joint Visualization Between the 70° and 30° Arthroscopes: A Cadaveric Study

2017 ◽  
Vol 11 (1) ◽  
pp. 72-76 ◽  
Author(s):  
Ichiro Tonogai ◽  
Fumio Hayashi ◽  
Yoshihiro Tsuruo ◽  
Koichi Sairyo
Keyword(s):  
Ankle Joint ◽  
Distal Tibia ◽  
Skin Incision ◽  
Surrounding Tissue ◽  
Osteochondral Lesions ◽  
Talar Dome ◽  
Kirschner Wires ◽  
Anterior Edge ◽  
Ankle Surgery ◽  
Anterior Ankle Impingement

Ankle arthroscopy is an important diagnostic and therapeutic tool. Arthroscopic ankle surgery for anterior ankle impingement or osteochondral lesions (OCLs) is mostly performed with a 30° arthroscope; however, visualization of lesions is sometimes difficult. This study sought to compare ankle joint visualization between 70° and 30° arthroscopes and clarify the effectiveness of 70° arthroscopy. Standard anterolateral and anteromedial portals were placed with 4-mm 70° or 30° angled arthroscopes in a fresh 77-year-old male cadaveric ankle. The medial ligament and surrounding tissue were dissected via a medial malleolar skin incision. Kirschner wires were inserted into the distal tibia anterior edge; 5-mm diameter OCLs were created on the medial talar gutter anteriorly, midway, and posteriorly. The talar dome and distal tibia anterior edge were visualized using both arthroscopes. The 70° arthroscope displayed the anterior edge of the distal tibia immediately in front of the arthroscope, allowing full visualization of the posterior OCL of the medial talar gutter more clearly than the 30° arthroscope. This study revealed better ankle joint visualization with the 70° arthroscope, and may enable accurate, safe, and complete debridement, especially in treatment of medial talar gutter posterior OCLs and removal of anterior distal tibial edge bony impediments. Levels of evidence: Level IV, Anatomic study

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

2018 ◽  
Vol 39 (4) ◽  
pp. 426-432 ◽  
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.

Anterolateral approach to the distal tibia for fixation of pilon fractures

2012 ◽  
Vol 23 (2) ◽  
pp. 111-115 ◽  
Author(s):  
Michael Khazzam ◽  
Gregory J. Della Rocca ◽  
Allison M. Wade ◽  
Yvonne M. Murtha ◽  
Brett D. Crist
Keyword(s):  
Distal Tibia ◽  
Anterolateral Approach ◽  
Pilon Fractures

Lateral Transfibular Approach to Tibial Pilon Fractures: A Case Report

2019 ◽  
Vol 109 (6) ◽  
pp. 459-462
Author(s):  
Bilgehan Tosun ◽  
Ozgur Selek
Keyword(s):  
Case Report ◽  
Surgical Treatment ◽  
Distal Tibia ◽  
Lateral Part ◽  
Pilon Fracture ◽  
Tibial Pilon ◽  
Tibial Pilon Fracture ◽  
Second Year ◽  
Pilon Fractures

We present a case of tibial pilon fracture where only the lateral part of the distal tibia was affected. The transfibular approach to the ankle was used for the surgical treatment of the fracture. After an initial nonweightbearing period of 3 weeks, full weightbearing was allowed 8 weeks after surgery. The second-year follow-up showed no evidence of degenerative signs, with full ankle range of motion.

External Fixation in the Treatment of Tibial Pilon Fractures: Comparison of Two Frames in Torsion

2007 ◽  
Vol 28 (7) ◽  
pp. 823-830 ◽  
Author(s):  
Aaron T. Scott ◽  
John R. Owen ◽  
Vishal Khiatani ◽  
Robert S. Adelaar ◽  
Jennifer S. Wayne
Keyword(s):  
External Fixation ◽  
External Fixator ◽  
Statistical Significance ◽  
Testing Machine ◽  
Distal Tibia ◽  
Materials Testing ◽  
Pilon Fracture ◽  
Tibial Pilon ◽  
Torsional Testing ◽  
Pilon Fractures

Background Ankle spanning external fixation has become the initial treatment of choice for complex tibial pilon fractures. Many fixator designs exist, but their biomechanical performance has not been studied extensively for this application. The goal of the present study was to compare the torsional performance of two commercially available frames, the Orthofix XCaliber and the Howmedica Hoffmann® II. Methods The XCaliber and the Hoffmann® II were each applied to six fresh cadaver lower extremities and were loaded in a materials testing machine. Strain gauges were attached to the anteromedial cortex of the distal tibia, and each specimen underwent torsional and axial load testing, with and without the external fixator. A simulated pilon fracture was created, and torsional testing was repeated. Results Results indicated that the XCaliber was significantly more rigid in internal rotation than the Hoffmann® II, before (49%) and after (41%) creation of the pilon fracture. Despite the XCaliber's increased rigidity relative to the Hoffmann® II (22% to 31%) in external rotation, statistical significance was not attained. Both fixators reduced strain (25% to 85%) at the anteromedial cortex upon torsional testing, but no significant differences between the two frames were noted. Conclusions The present study demonstrates that the XCaliber has mechanical advantages over the Hoffmann® II in terms of torsional rigidity for a tibial pilon fracture. Clinical Relevance Increased rigidity of the XCaliber could potentially lead to decreased time to union, and a lower incidence of pin loosening and would prove beneficial in a setting in which the external fixator is used as the definitive fixation.

scholarly journals Extra-articular distal tibia fibula fracture managed with single posterolateral approach: a case report

2021 ◽  
Vol 7 (3) ◽  
pp. 683
Author(s):  
Neetin P. Mahajan ◽  
Prasanna Kumar G. S. ◽  
Tushar C. Patil ◽  
Kartik P. Pande ◽  
Harish Pawar
Keyword(s):  
Distal Tibia ◽  
Posterolateral Approach ◽  
Anterolateral Approach ◽  
Ankle Motion ◽  
Fibula Fracture ◽  
Left Ankle ◽  
Alternative Approach ◽  
Soft Tissue Problems ◽  
Tibia Fractures ◽  
Distal Tibia Fractures

<p class="abstract">Extra-articular distal tibia fractures involve distal tibia approximately 4 cm within tibia plafond with no articular extension. The proper preoperative care, planning and selection of surgical approach is very essential to prevent postoperative wound-related complications. We present a case of a 29 year female patient, presented with left ankle pain and swelling with a wound over the medial aspect of the ankle. X-ray of the left ankle showed extra-articular distal tibia fibula fracture with no neurovascular deficit. We managed both the fractures with open reduction and internal fixation using a single posterolateral approach. At present 1 year follow-up, the patient is having a good range of ankle motion with radiological union with no implant failure and wound-related complications. Extra-articular distal tibia fibula fracture fixation using single posterolateral approach is a viable alternative approach to medial or anterolateral approach in cases of medial or anterior soft tissue problems. It helps in getting a better functional outcome, early mobilisation with less wound-related complications.</p>

scholarly journals Should Complex Comminuted C3-Type Tibial Pilon Fractures Be Fused or Fixated? A Systematic Review

2021 ◽  
Author(s):  
Yash Paul Chaudhry ◽  
Efstratios Papadelis ◽  
Hunter Hayes ◽  
Philip F. Stahel ◽  
Erik A. Hasenboehler
Keyword(s):  
Fracture Fixation ◽  
Complication Rate ◽  
Wound Complication ◽  
Ankle Arthrodesis ◽  
Pilon Fracture ◽  
Eligibility Criteria ◽  
Tibial Pilon ◽  
Mesh Terms ◽  
The Mean ◽  
Pilon Fractures

Abstract Background: Comminuted intra-articular tibial pilon fractures can be challenging to manage, with high revision rates and poor functional outcomes. This study reviewed (1) treatment, complications, and clinical outcomes in studies of complex comminuted tibial pilon fractures (type AO43-C3); and (2) primary ankle arthrodesis as a management option for these types of complex injuries.Methods: A systematic literature search was performed on PubMed from 1990-2020 to determine complications and outcomes after staged fracture fixation and primary ankle joint arthrodesis for comminuted C3-type tibial pilon fractures.The search was conducted in compliance with the PRISMA guidelines, using the following MeSH terms: “tibial pilon”/“pilon fracture”/“plafond fracture”/“distal tibial”/“43-C3”/“ankle fracture”/“ankle fusion”/“primary ankle arthrodesis”/“pilon fracture staged”/“pilon external fixation” and “pilon open reduction internal fixation.” Inclusion criteria were restricted to original articles in English language on adult patients ≥18 years of age. Eligibility criteria for retrieved publications were determined using a “PICO” approach (population, intervention/exposure, comparison, outcomes). Weighted analysis was used to compare treatment groups on time to definitive treatment, follow-up time, range of motion, fracture classification, and complications.Results: The systematic literature review using the defined MeSH terms yielded 72 original articles. Of these, 13 articles met the eligibility criteria based on the PICO statements, of which 8 publications investigated the outcomes of a staged fixation approach in 308 cumulative patients, and 5 articles focused on primary ankle arthrodesis in 69 cumulative patients. For staged treatment, the mean wound complication rate was 14.6%, and the malunion/nonunion rate was 9.9%. For primary arthrodesis, the mean wound complication rate was 2.9%, and the malunion/nonunion rate was 2.9%. After risk stratification for fracture type and severity, the small cumulative cohort of patients included in the primary arthrodesis publications did not provide sufficient power to determine a clinically relevant difference in complications and long-term patient outcomes compared to the staged surgical fixation group.Conclusions: At present, there is insufficient evidence in the published literature to provide guidance towards consideration of ankle arthrodesis for complex comminuted C3-type tibial pilon fractures, compared to the standard treatment by staged surgical fracture fixation.

Osteonecrosis of the distal tibia after pilon fractures

2020 ◽  
Vol 26 (8) ◽  
pp. 895-901
Author(s):  
David J. Cinats ◽  
Trevor Stone ◽  
Darius Viskontas ◽  
Kelly Apostle
Keyword(s):  
Distal Tibia ◽  
Pilon Fractures

scholarly journals The Role of Occlusion in the Dental Implant and Peri-implant Condition: A Review

2016 ◽  
Vol 10 (1) ◽  
pp. 594-601 ◽  
Author(s):  
Carmen V. Graves ◽  
Steve K. Harrel ◽  
Jeffrey A. Rossmann ◽  
David Kerns ◽  
Jorge A. Gonzalez ◽  
...  
Keyword(s):  
Dental Implants ◽  
Dental Implant ◽  
Scientific Literature ◽  
Dental Treatment ◽  
Treatment Approach ◽  
Human Studies ◽  
Study Designs

Dental implants have become a widely used dental treatment approach. It is important to identify factors that can be detrimental to dental implants and the peri-implant complex. There is controversy regarding whether occlusion plays a role in the implant and peri-implant condition. The present study aims to review the scientific literature regarding this topic. Animal and human studies, and previous reviews on the topic are included and presented. There is a wide heterogeneity among study designs. Several articles demonstrated that occlusion and occlusion overload could detrimentally affect the peri-implant condition, while other articles did not support these results. More studies are needed to help understand the mechanisms by which occlusion might play a role in the peri-implant condition.

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