C-Type Pilon Fracture – Open Reduction and Internal Fixation with Stryker AxSOS 3 Periarticular Plating System surgical technique
Subscribe to get full access to this operation and the extensive Foot Surgery Atlas.
Learn the C-Type Pilon Fracture – Open Reduction and Internal Fixation with Stryker AxSOS 3 Periarticular Plating System surgical technique with step by step instructions on OrthOracle. Our e-learning platform contains high resolution images and a certified CME of the C-Type Pilon Fracture – Open Reduction and Internal Fixation with Stryker AxSOS 3 Periarticular Plating System surgical procedure.
Pilon fractures are defined as intra-articular fractures of the distal tibial plafond and being in a load bearing joint they are serious and usually life changing fractures. The fracture is produced by a mixture of shear and compressive loads to the distal tibial metaphysis. Often such fractures are associated with other severe injuries to the ipsilateral limb, pelvis or lumbar spine.
Pilon fractures make up between 5 and 10% of all lower limb fractures and because of the energy involved are associated with a high (15 – 55%) complication rate.
Significant rotational force alone can also cause distal tibial fractures involving the plafond and these are also Pilon fractures. This mechanism though usually results in less severe soft tissue damage and less compromise to the articular surface in terms of comminution and cartilage damage.
The most frequent mechanism of injury is a fall from height though road traffic accidents also account for a good proportion of high energy Pilon fractures. This patient also sustained an ispilateral open femoral fracture which was plated on day one of the injury when a temporising external fixator was applied in a delta construct to the ankle.
In terms of operative management, the big debate is when to use ORIF or minimally invasive plate osteosynthesis (MIPO), and when to use an external fixation frame (such as an Ilizarov or other fine wire construct) as definitive treatment. It is with this in mind that there is currently a multi-centre randomised control trial comparing these two forms of treatment, funded by the NIHR (National Institute for Health Research) in the UK. This study is called the ACTIVE Trial (Articular Type C Pilon Trial Internal Vs External Fixation) being run by the York Trials unit. This patient was recruited into this trial and randomised to Internal Fixation.
In my hands and working in a unit with excellent fine wire fixation skills we treat those cases where there is very severe soft tissue damage, or where the articular surface is grossly comminuted, with a frame. Those cases where the degree of articular comminution is less severe are usually treated with plate fixation as with the case presented here.
Readers will also find of interest Chris Blundells other OrthOracle instructional technique for surgical treatment of a Pilon fracture Internal fixation of distal tibial Pilon fracture using Stryker AxSOS 3Ti plate. and also Paul Fentons technique Open reduction and internal fixation of C-type Pilon fracture using Smith and Nephew EVOS small fragment system.
Author: Mr Chris Blundell FRCS (Tr & Orth)
Institution: Northern General Hospital, Sheffield, UK
- Each operation and the questions associated become a named course in the CPD section
- The operative technique itself is read as a lesson as is any company implant information if this is being assessed.
- You’ll need to tick the box to confirm this has been done and can do this immediately if you have already read the op tech.
- The vast majority of operations have a 10-15 MCQ quiz covering all aspects of the decision making and the technique
- There are four possible answers of which one is correct (or on occasion more correct) than the others.
- There are additional quiz modules on the surgical steps, the implants and problem cases being added continually
- The course is completed once all the lessons are read and quizzes submitted and passed.
- On successful completion of each quiz you will receive validated CPD points that add to the certificate in your CPD folder.
- Your dashboard also will contain a record of the time you have spent logged onto and using the site.
- The timer suspends after 5 minutes though if there is no activity.
- When you restart you will resume at the same point in the module.
- Once you have completed each quiz you will need to feedback on the module first then click “submit” and your paper will be marked.
The pass mark is 75%.
- If you fall below this level you will be directed back to re-read the slides where you’ve tripped up.
- Once these have been read you can re-do just the questions you failed on.
- Once you have passed the quiz you can return at a future stage & resit .
- Operation Quiz – 1 CPD point
- Surgical steps Quiz – 1/4 CPD point
- Implants Quiz – 1/4 CPD point
- Problem case Quiz – 1/2 CPD point
One CPD point equates to one hour of academic activity
Welcome to the Professional Development question section. The objective of taking these tests is to demonstrate that you have understood all aspects of the assessment and management of patients requiring surgical intevention. On successful completion you will receive a certificate accredited by both the Royal College of Surgeons of both England and Edinburgh as well as the British Orthopaedic Association.
Our content is designed for both Surgeons in independent practice and Surgeons in training.