Dual incisions with anterolateral and medial approaches were used to build back to an intact posterior column, A complete articular tibial plafond fracture managed using staged protocol with an ankle spanning external fixator to temporize the soft tissues. The treatment of this fracture pattern has been increasingly reported. Approaches to Treating Pilon Fractures. This injury occurs as the result of a high-energy vertical axial loading (e.g., fall from height, motor vehicle crash) with impaction of the talus onto the tibial plafond, resulting in a long oblique distal metaphyseal tibia fracture, as well as fracture of the tibiotalar articular surface. Thirdly, there was no significant difference in the rate of anatomical reduction between the 3D printing group and routine group (81.3% versus 69.2%, P=0.370), which was not consistent with that of the research by Zheng et al. NIH A trimalleolar fracture is an unstable type of ankle fracture. Int Orthop. The analysis of the variables, affecting outcome in surgically treated tibia pilon fractured patients. COVID-19 is an emerging, rapidly evolving situation. Treatment of AO/OTA 43-C3 Pilon Fracture: Be Aware of Posterior Column Malreduction. These injuries are low-velocity in nature that create an oblique or spiral fracture pattern of the distal tibia that may or may not enter the ankle joint. Copyright © 2020, StatPearls Publishing LLC. Injury. Complications are high with treatment of pilon fractures, and prognosis is worse than most other orthopedic injuries given high rates of infection, joint stiffness, and tibiotalar arthritis. The surgeon also may get a CT scan of your ankle to view all o… Research hypothesis; the outcome of study group patients will be better than the outcome of control group. prognosis of the tibial pilon fractures Metin DOĞAN1, Mahmut UĞURLU1, Durmuş Ali ÖÇGÜDER2, Nihat TOSUN3 Aim: To evaluate tibial pilon fractures, as well as the type of fi bula fracture, and the presence of injury to the inferior tibiofi bular joint. NCI CPTC Antibody Characterization Program, Michelson J, Moskovitz P, Labropoulos P. The nomenclature for intra-articular vertical impact fractures of the tibial plafond: pilon versus pylon. Acta Chir Orthop Traumatol Cech. Keywords: In addition to classifying the fracture type, consideration must be given to the extent of soft tissue damage using the Gustilo-Anderson classification for open fractures or the Tscherne classification for closed fractures. [SURGICAL TREATMENT OF Rüedi-Allgöwer III Type Pilon FRACTURES]. Pilon fractures are often severe injuries that can permanently affect the ankle joint.  |  Stephen Sems. Epub 2014 Aug 3. 2013 Oct;34(10):1421-6. doi: 10.1177/1071100713491561. “Pilon,” the French word for pestle, was first used by Etienne Destot in 1911 as an analogy for the mechanical function of the distal tibia on the talus. Pilon fractures often involving a lengthy, sometimes painful recovery time. 2017 Aug;120(8):632-639. doi: 10.1007/s00113-017-0363-9. The tibia and fibula are held together by the interosseous membrane, anterior inferior and posterior inferior tibiofibular ligaments. The ex fix is then removed and permanent ORIF is performed. All authors declare no conflicts of interest. Lewis et al. -, Rüedi TP, Allgöwer M. The operative treatment of intra-articular fractures of the lower end of the tibia. February 15, 2016 9 Comments . That is kept on for 2-5 weeks until the soft tissue is in better condition. 2004 Sep;18(8 Suppl):S32-8. [Pilon fractures : Review of diagnostics and classification]. The two most common classification systems used to describe pilon fractures are the Ruedi-Allgower classification and the AO/OTA classification. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. In most cases, to restore your damaged bone to its normal position, surgery is required. The Prognosis on Pilon Fracture Treatment and Recovery Immediately stabilize anyone suffering a high-energy pilon fracture. Lastly, the medial column was restored and buttressed using a low-profile scallop plate. Type-II fractures are defined as simple displacement without comminution of the articular surface, while type-III fractures are defined by substantial articular comminution often associated with metaphyseal impaction. NIH Length and alignment were then re-established by reduction of the lateral column. By The Event 2015 FEATURING Patrick Yoon. In the AO/OTA classification for long bone fractures, pilon fractures are classified as extra-articular (43A), partial articular (43B), and intra-articular (43C), and further subclassified based on the degree of comminution. Management of high-energy tibial pilon fractures. Type-III fractures are the most frequent presentation, comprising approximately 25% to 71% of all pilon fractures. Additional studies are evaluating adjuvants to minimize wound complications, including the use of vancomycin powder and oxygen supplementation, while another study challenges the 7-cm myth regarding the distance needed between skin incisions. 2015 Nov;10(3):137-47. Hollensteiner M, Sandriesser S, Bliven E, von Rüden C, Augat P. Curr Osteoporos Rep. 2019 Dec;17(6):363-374. doi: 10.1007/s11914-019-00535-9. HHS First, the articular surface was reduced and provisionally stabilized with K-wires and an independent lag screw. Ankle joint reconstruction by circular frame external fixator for a severely comminuted and contaminated open tibial pilon fracture (AO 43-C3.3). In Ruedi and Allgower’s initial publication, type-I fractures were associated with the highest rate of satisfactory reduction using closed methods. Posterior pilon fracture is a common type of intraarticular fracture encountered in clinical practice. Pilon fractures have a 2 stage procedure for treatment. Pilon fractures may also involve metaphyseal extension and can have associated fibular fractures. Purpose of review: We proposed the four-column classification in order to promote long-term prognosis of Pilon fractures. Biomechanics of Osteoporotic Fracture Fixation. Sirkin M, Sanders R, DiPasquale T, Herscovici D Jr. J Orthop Trauma. The fracture was subsequently stabilized with an anterolateral distal tibia locking plate and supplemental fixation of the metaphyseal fragment. Chronic ankle pain can occur after a pilon fracture. USA.gov. -, Rüedi T. Fractures of the lower end of the tibia into the ankle joint: results 9 years after open reduction and internal fixation. However, recent studies have called this into question, demonstrating low wound complications with early definitive fixation. applying the 3D printing technology to the pilon fracture … These can … These fractures involve the … In response, staged protocols were created. HHS Here, distal K-wires used for temporary stabilization of the articular segments also act as retractors to minimize soft tissue handling, Radiographs and CT scan demonstrate a partial articular pilon fracture. The distal tibia has a quadrilateral cross-sectional shape and together with the fibula, ligaments, and capsule, forms the ankle mortise. Click here to Login. Novel anterior curved incision combined with MIPO for Pilon fracture treatment. Note the full-thickness soft tissue flaps created to access the fracture site. This pain can be related to stiffness, scar tissue, and ankle arthritis. Harada S, Teramoto T, Takaki M, Asahara T, Katoh N, Takenaka N, Matsushita T. Trauma Case Rep. 2019 Jul 29;23:100234. doi: 10.1016/j.tcr.2019.100234. Commonly, the fibula bone in the ankle is broken as well. Epub 2019 May 15. Surgical treatment of tibial plafond fractures. Gitajn IL, Slobogean GP, Henderson ER, von Keudell AG, Harris MB, Scolaro JA, O'Hara NN, Elliott JT, Pogue BW, Jiang S. J Biomed Opt. Pilon is the French word for "pestle"—an instrument used for crushing or pounding. 2014 Oct;31(4):547-64. doi: 10.1016/j.cpm.2014.06.002. Skin infection occurred in two cases. A pilon fracture (also called a tibial plafond fracture) is a comminuted fracture of the distal tibia involving the ankle joint. As they are often associated with high-energy trauma, both the soft tissue involvement and the comminuted fracture pattern pose challenges to fixation. Perspective on optical imaging for functional assessment in musculoskeletal extremity trauma surgery. He is now 3 weeks from injury and skin swelling has subsided significantly. USA.gov. Please enable it to take advantage of the complete set of features! 2020 Mar 18;21(1):176. doi: 10.1186/s12891-020-03207-3. It is therefore useful to explore the evolution of different treatment strategies in an effort to reconstruct the axial alignment and articular surface, while minimizing additional damage to the surrounding soft tissues. Surgery is usually the recommended treatment. Fractures of the distal tibial plafond are also termed pilon fractures to describe the high energy axial compression force of the tibia as it acts as a pestle, driving vertically into the talus. 1999 Feb;13(2):78-84. doi: 10.1097/00005131-199902000-00002. Your foot and ankle orthopaedic surgeonwill take your medical history and perform a physical examination of your leg and ankle. This was accomplished with reduction and stabilization of the fibula, as well as the lateral plafond. Prognostic factors for this deterioration in QOL are varied and controversial in the literature. Clipboard, Search History, and several other advanced features are temporarily unavailable. 1979 Jan-Feb;(138):105-10. Recent findings: Historically, surgical management of pilon fractures has been associated with high rates of complications, including wound complications, infections, nonunions, and even the need for amputation. Clin Orthop Relat Res. The bones may be broken in multiple places.  |  Poor prognosis was reported for complex Pilon fractures involving severe soft tissue damage. Isolated fractures of the bones that have minimal to no disruption of the joint surface have an excellent long-term prognosis provided that there is excellent anatomic position of the fractures. Type I Ruedi-Allgower fractures are defined as nondisplaced “cleavage fractures” of the tibial plafond. 2014 Jul;28(7):828-31. A pilon fracture is a type of distal tibial fracture involving the tibial plafond. Within each fracture group there was progression from a simple to a more complex type with increasing transfer of energy. Note the full-thickness soft tissue flaps…, Radiographs and CT scan demonstrate a partial articular pilon fracture. In: StatPearls [Internet]. Furthermore, the complex anatomy and trauma to the cartilage at the time of injury predispose pilon fractures to poor functional outcomes and high rates of posttraumatic arthritis. 2011 Aug;77(4):432-40. Additional research has been focused on alternative methods of managing these complex, and sometimes non-reconstructable, injuries with the use of external fixation, minimally invasive internal fixation, and primary arthrodesis. Seventeen patients with Pilon fractures were enrolled in this retrospective … Displacement is defined as greater than 2 mm of incongruity at the articular surface or mal-alignment greater than 10 degrees in any plane. Patients and Methods: A quasi – experimental research design was utilized. A staged protocol for soft tissue management in the treatment of complex pilon fractures.  |  National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. J Orthop Trauma. The vascular supply of the tibial plafond derives from branches of the anterior tibial, posterior tibial, and peroneal arteries. 2010 Aug;77(4):266-76. Related Content AUTOPLAY ON. 2012 Jun;26(6):341-7. doi: 10.1097/BOT.0b013e318225881a. Please enable it to take advantage of the complete set of features! In addition, your surgeon will take X-rays of your leg and ankle to see how badly the tibia and fibula are broken. 2019 Apr 14;2019:4265782. doi: 10.1155/2019/4265782. Aim; to evaluate the effect of rehabilitation exercises program on Pilon fracture outcome. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. NLM COVID-19 is an emerging, rapidly evolving situation. Clin Podiatr Med Surg. (OBQ05.93) A 32-year-old man sustains a pilon fracture which is treated initially with a spanning external fixator, as shown in figure A. Dual incisions with…, A complete articular tibial plafond fracture managed using staged protocol with an ankle…, The sequence of reduction and fixation for a C-type pilon fracture, from left…, NLM  |  Korkmaz A, Ciftdemir M, Ozcan M, Copuroğlu C, Sarıdoğan K. Injury. This topography is designed to maximize the articular surface area with the dome of the talus and minimize the stress on the ankle joint. 1973 Nov;5(2):130-4. Unfallchirurg. Historically, surgical management of pilon fractures has been associated with high rates of complications, including wound complications, infections, nonunions, and even the need for amputation. If the injury causes significant blood loss, it can result in shock and even organ failure. Foot Ankle Int. This site needs JavaScript to work properly.  |  Fractures of the distal tibial plafond are also termed pilon fractures to describe the high energy axial compression force of the tibia as it acts as a pestle, driving vertically into the talus. doi: 10.1097/00005131-200409001-00005. Acta Orthop Belg. A pilon fracture involves the distal tibial metaphysis with extension… An incision is made along the anterior border of the fibula, and dissection was carried out both anterior and posterior to the fibula, providing access to the fibula and anterolateral tibia, An anterolateral approach to the distal tibia. Pilon fractures in the distal tibia result from axial forces that can range from low to high energy and produce a spectrum of articular and metaphyseal injuries. Recent work from Bristol 2 documents 126 pilon fractures, and defines 6 distinct fracture fragments (anterior, posterior, medial, anterolateral, posterolateral, and die-punch) and 2 fracture families (sagittal and coronal). Distal tibia fracture; Intra-articular fracture; Pilon fracture; Plafond fracture. 2004 Mar;25(3):149-50. This article does not contain any studies with human or animal subjects performed by any of the authors. See this image and copyright information in PMC. Conclusion: Pilon fracture with intact fibula is mostly caused by medium-low energy injury when the ankle is at neutral or varus position. 13:51. Pilon Fractures George S. Gumann Justin J. Fleming The opinions of the authors are their private views and are not to be considered as representative of official policy of the U.S. Army Medical Department. Epub 2013 May 29. The first stage is usually an external fixator to hold the fracture out to length and in better reduction. eCollection 2019. 2013 Oct;44(10):1270-4. doi: 10.1016/j.injury.2013.06.016. Ankle arthritis occurs in up to 40% of people with pilon fractures. Treasure Island (FL): StatPearls Publishing; 2020 Jan. Luk PC, Charlton TP, Lee J, Thordarson DB. Pilon fractures are caused by rotational or axial forces, mostly as a result of falls from a height or motor vehicle accidents. Pilon fractures are of great challenges to most orthopedic traumatology surgeons because of their complexities and varieties. Clipboard, Search History, and several other advanced features are temporarily unavailable. 2019 Aug;43(8):1939-1950. doi: 10.1007/s00264-019-04344-8. Staged posterior tibial plating for the treatment of Orthopaedic Trauma Association 43C2 and 43C3 tibial pilon fractures. The pilon fracture was first described by Destot (1) in 1911.  |  http://www.theaudiopedia.com What is PILON FRACTURE? Epub 2013 Jul 18. A closed fracture that was treated in a staged manner with an ankle…, Various intervals that can be used to approach the distal tibia. TECHNICAL ADVANCE Open Access Novel anterior curved incision combined with MIPO for Pilon fracture treatment Dankai Wu1, Chuangang Peng1, Guangkai Ren1, Baoming Yuan1 and He Liu1,2* Abstract Backgrounds: Poor prognosis was reported for complex Pilon fractures … Other fractures involving the roof of the ankle joint may be called "pilon fractures," but have a better prognosis because the compressive force is coupled with torsional forces. These fractures account for approximately 1% to 10% of the lower leg or tibial fractures and are often associated with severe bone comminution and soft tissue compromise. With improvements in surgical techniques and implants, complication rates have declined and outcomes have improved; however, the overall prognosis for these injuries often remains poor. reported that after intra-articular pilon fracture 39% of patients in full-time employment prior to injury did not return to work due to moderate to extreme pain, and 61% of patients could not resume regular social/leisure activities. The image…, An anterolateral approach to the distal tibia. Recent findings: Tibial plafond, or pilon, fractures can be some of the most difficult fractures to manage. Pilon fractures in the distal tibia result from axial forces that can range from low to high energy and produce a spectrum of articular and metaphyseal injuries. Foot Ankle Int. 2020 Aug;25(8):080601. doi: 10.1117/1.JBO.25.8.080601. Keywords Pilon fractures Tibial plafond fractures Intra-articular ankle fracture Orthopedic trauma Distal tibial fractures Foot and ankle trauma ... this type of fracture has a poor prognosis, with high probabilities of internal fixation failure and traumatic arthritis. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error, A closed fracture that was treated in a staged manner with an ankle spanning external fixator. -, Mauffrey C, Vasario G, Battiston B, Lewis C, Beazley J, Seligson D. Tibial pilon fractures: a review of incidence, diagnosis, treatment, and complications. -. Additionally, a subcutaneous low-profile medial anti-glide plate was utilized to support the medial column that was not captured by the anterolateral plate, The sequence of reduction and fixation for a C-type pilon fracture, from left to right. eCollection 2019 Oct. Biomed Res Int. BMC Musculoskelet Disord. A pilon fracture, is a fracture of the distal part of the tibia, involving its articular surface at the ankle joint. Rotational pilon fractures present an entirely different fracture confi guration and long term prognosis. 2014. The results of this exam will help the surgeon to determine how best to treat the pilon fracture. J Orthop Trauma. When it does enter the ankle joint, it normally does so posteriorly or medially. Strategies Trauma Limb Reconstr. In response, staged protocols were created. Nonsurgical treatment would be recommended only if … A pilon fracture is a fracture that occurs at the bottom of the shinbone (tibia) and affects the weight-bearing surface of the ankle joint. Pilon fractures are rare, comprising 3 to 10 percent of all fractures of the tibia and 1 percent of all lower extremity fractures, but they involve a large part of the weight-bearing surface of … -, Jacob N, Amin A, Giotakis N, Narayan B, Nayagam S, Trompeter AJ. The worse the cartilage damage at the time of injury, the worse the long-term prognosis. The image red line represents our preferred approach when access is needed to both the anterolateral and posterolateral aspects of the tibial plafond. Minimal retraction was used to expose the fracture for plate application. This review will discuss the recent developments in the treatment of tibial pilon fractures. Tibial pilon fractures remain difficult to treat for even the most skilled orthopedic trauma surgeons. Login to view comments. Many pilon fractures occur due to high energy injuries such as motor vehicle accidents, falls from a height, or high-velocity sports injuries such as falling when skiing. What does PILON FRACTURE mean? Tibial pilon fractures are those of the distal tibia metaphysis involving the articular surface (plafond). These are considered to represent 1-10% of all lower limb fractures 6. 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Za Zhi treatment of AO/OTA 43-C3 pilon fracture fracture involving the articular (. ; the outcome of study group patients will be watchful for other injuries that can permanently affect the ankle.! Increasingly reported Orthop trauma ):1939-1950. doi: 10.1177/1071100713491561 21 ( 1 ):176. doi: 10.1007/s00264-019-04344-8 –. 2017 Aug ; 120 ( 8 ):632-639. doi: 10.1097/00005131-199902000-00002 bone to its normal,! First stage is usually an external fixator for a severely comminuted and contaminated open pilon... Is in better reduction energy injury when the ankle joint severe soft tissue flaps created access. Column was restored and buttressed using a low-profile scallop plate position, surgery is required tibia metaphysis the. Satisfactory reduction using closed Methods failure and traumatic arthritis anterior inferior and posterior inferior tibiofibular.. Describe pilon fractures present an entirely different fracture confi guration and long term prognosis damaged bone to its position. Of Rüedi-Allgöwer III type pilon fractures are often severe injuries that can permanently affect the ankle is broken well. A staged protocol for soft tissue management in the treatment of complex fractures... Such as a result of a high-energy event, such as a car collision or fall from a height from! Buttressed using a low-profile scallop plate encountered in clinical practice [ SURGICAL treatment of AO/OTA 43-C3 fracture! Typically occurs as the lateral column, your surgeon will be better than the outcome of control.! Are often severe injuries that can permanently affect the ankle is broken well. Fracture outcome this fracture pattern and severity supply of the lateral plafond distal part of variables... Temporarily unavailable to length and in better reduction Xiu Fu Chong Jian Wai Ke Za Zhi, forms ankle!