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The first 25 slides, exactly as they appear. The full deck has 84 content slides.
Orthopaedics
Pilon Fractures
Built from Tang — Orthopaedic Trauma Vol 2: Lower Extremity
What’s inside
9 sections · 84 slides
Overview
- What we will build up, step by step
Basic Theory and Concepts
Anatomy, injury mechanism, and classification
- What a pilon fracture actually is
- Pilon fractures are rare but high-impact
- Why pilon fractures are difficult and dangerous
- Applied anatomy: the three players in a pilon fracture
- The three structures in a pilon fracture
- How the fibula changes the injury pattern
- The distal articular surface of the tibia and fibula
- The distal joint surface: the ankle mortise
- Mechanism of injury: how the forces break the bone
- Axial compression of the talus into the plafond
- Axial compression — the classic “plafond” fracture
- Shear force splitting the joint surface
- Shear force — the splitting injury
- Combined external forces
- Foot position at impact decides the fracture pattern
- Why foot position matters at the moment of impact
- Pilon fracture vs ordinary ankle fracture
Classification of Pilon Fractures
Rüedi–Allgöwer and AO systems
- The Rüedi–Allgöwer classification of pilon fractures
- Rüedi–Allgöwer classification
- The AO classification of distal tibial fractures
- AO classification — most pilon fractures are Type C
Preoperative Assessment
Clinical, soft-tissue, and imaging work-up
- Clinical assessment: read the injury before the X-ray
- Soft-tissue assessment: the deciding factor for timing
- Imaging: seeing the fracture in full
- CT scans and the typical fragment layout
- The CT fragment map
Surgical Treatment
Indications, timing, and staged strategy
- Surgical indications: who needs an operation
- The four surgical goals (the purpose of operating)
- Timing of surgery: the single most important decision
- The staged (“span, scan, plan, fix”) strategy
- Should the fibula be fixed in Stage I? An honest debate
Surgical Technique I
Limited open reduction and trans-ankle external fixation
- Entry points for the distal Schanz pins in the foot
- Placing the Schanz pins with the aid of a guider
- How a trans-ankle external fixator is built
- Installing the external fixation frame
- Staged fixation then second-stage plating
- Trans-ankle frame with limited internal fixation
Surgical Technique II
Open reduction and internal fixation (ORIF)
- The surgical approaches to the distal tibia and fibula
- Choosing and spacing the approaches
- Vessels and nerves to protect during the approaches
- The neurovascular structures at risk
- Patient positioning for the anteromedial approach
- Marking the anteromedial incision by surface projection
- Deep exposure of the anterior tibia and ankle joint
- The anteromedial approach, step by step
- The anterolateral approach to the distal tibia
- The reduction sequence: a fixed order of operations
- Reducing the fibula restores the tibia
- Why the fibula is reduced first
- Flipping the Chaput fragment open
- Reconstructing the articular facet: open the book
- Reducing the posterior Volkmann fragment
- Reducing the Volkmann (posterior) fragment
- Reducing the joint surface against the talus
- Rebuilding the joint surface: the talus is the mould
- Positioning the internal fixation plates
- Choosing the internal fixators
- Closing the wound and after-care
- Rehabilitation timeline after fixation
Cases and Complications
What good and poor outcomes look like
- A successfully treated left tibial pilon fracture
- A pilon fracture with both tibial and fibular fixation
- Complication 1 — wound problems and infection
- A pilon fracture course complicated by deep infection
- Complication 2 — malunion and nonunion
- Matching the plate to the fracture
- A pilon fracture ending in nonunion and arthrodesis
- Complication 3 — post-traumatic arthritis and stiffness
Summary
The essentials to carry away
- Key takeaways
- Why is the fibula reduced and fixed FIRST in a pilon fracture?
- References (1/4)
- References (2/4)
- References (3/4)
- References (4/4)
- Orthopaedic Trauma Surgery — Volume 2: Lower Extremity