Internal fixation of distal tibial Pilon fracture 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.
Author :Mr Chris Blundell FRDS (Tr & Orth)
Institution: The Northern General Hospital , Sheffield ,UK.
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Question 1 of 15
Which one is the most common mechanism involved in creating a pilon fracture?CorrectIncorrect
Question 2 of 15
Which one of the following is LEAST often associated with pilon fractures?CorrectIncorrect
Question 3 of 15
Regarding timing of surgery which one describes when it is safe to conduct open reduction and fixation?CorrectIncorrect
Question 4 of 15
In terms of assessment of the injured limb which one of these statements is true?CorrectIncorrect
Question 5 of 15
Regarding the approach to the fracture which one of these statements is correct?CorrectIncorrect
Question 6 of 15
In order to gain a good view of the fracture which one of the following is best?CorrectIncorrect
Question 7 of 15
Which one of the following statements about Fracture reduction is correct ?CorrectIncorrect
Question 8 of 15
Which one of the following is the principle first stage of open reduction of pilon fractures?CorrectIncorrect
Question 9 of 15
To stabilise the articular fragments which one of the following is correct ?CorrectIncorrect
Question 10 of 15
For fixation of the fracture which one of the following statements about the plate is correct ?CorrectIncorrect
Question 11 of 15
Regarding the shape of the plate which one of the following is true?CorrectIncorrect
Question 12 of 15
For the AxSOS 3 Ti plate system which one of the following is correct ?CorrectIncorrect
Question 13 of 15
For the final plate position which one of the following is acceptable?CorrectIncorrect
Question 14 of 15
Regarding wound closure which one of the following statements is correct?CorrectIncorrect
Question 15 of 15
For post-operative care which statement one is most applicable?CorrectIncorrect