Pilon fracture: Internal fixation using Stryker AxSOS 3Ti plate



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Pilon fractures are fractures of the distal tibial plafond and by definition are intra-articular and in a load bearing joint, this renders them serious and often life changing fractures. The fracture is sustained by a mixture of shear and compressive loads to the distal tibial metaphysis.

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 can also cause distal tibial fractures which involve the plafond and these are also pilon fractures. This mechanism though usually has 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 and this case demonstrates this , being sustained after a 4 metre fall onto concrete through a weak roof .

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. In my hands and working in a unit with excellent fine wire fixation skills locally we tend to 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 was the case presented here.

OrthOracle readers will also find the following instructional operative techniques of use:

Pilon fracture: C-type fixed using Smith and Nephew EVOS small fragment system.

Pilon Fracture: C-type fixed with Stryker AxSOS 3 Periarticular Plating System

Pilon fracture: Internal fixation using Stryker AxSOS 3Ti plate.

Ankle fracture: Arthrex tightrope for acute syndesmotic injury and Stryker Variax plate for fibula fracture

Ankle fracture : Fibula pro-tibia fixation technique with Stryker Variax plate.

Ankle fracture: Medial malleolar fixation with ASNIS screws

Ankle fracture: Postero-lateral plating of pronation-external rotation ankle fracture (posterior malleolus))

Ankle fracture: Lateral malleolar fixation using Acumed Fibula Rod System

Author: Mr Chris Blundell FRDS (Tr & Orth)

Institution: IThe Northern General Hospital, Sheffield, UK.

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