Classification
Initial Evaluation
Treatment
Complications
Podpourri
100
This is the most common classification used for pilon fractures?
What is Ruedi and Allgower?
100
What imaging should you get to assess pilon fractures?
Radiographs: AP, mortise, lateral. CT scan.
100
What treatment is best indicated for type I pilon fractures?
Cast/splint/fracture brace. Non-surgical. Non weightbearing for 12 weeks.
100
What is the most common late complication of pilon fractures?
Traumatic arthritis.
100
True or false? There is always a fibular fracture associated with a pilon fracture.
False. There is usually, but not always.
200
This Stage of Ruedi and Allgower consists of a fracture of the distal tibia without significant displacement.
What is Ruedi Allgower Type I?
200
What should be evaluated on CT scans?
Degree of comminution, articular step-offs of joint surface. Also identify the key fragments that would aid in restoration of the tibial articular surface and metaphysis.
200
True or false. Primary arthrodesis is commonly indicated for pilon fractures.
False. Usually ankle arthrodesis is undertaken on a delayed basis (taking soft tissue envelope, difficulty in obtaining compression which is important for consolidation).
200
How is traumatic arthritis best addressed surgically?
Ankle arthrodesis.
200
What is another name for pilon fractures?
Explosion fracture of the distal tibia.
300
This Stage of Ruedi and Allgower consists of a fracture if the distal tibia with severe comminution, significant displacement, and loss of the cancellous weight-bearing portion of the tibial plafond.
What is Type III?
300
According to McGlamry, it is important to evaluate the location of the major fracture lines for these reasons:
Enhances incision planning, can aid in exposure of the fracture while preserving soft tissue attachments and maintaining vascularity.
300
Should you delay surgical intervention if ruptured fracture blisters are present? Why?
Yes. May need to delay surgery 7-10 days. Ruptured fracture blisters can increase the risk of infection, as it remains colonized by bacteria until it is completely epithelialized.
300
How soon will post-traumatic arthritis occur after the original injury?
One year.
300
If the position of the foot is inverted at the time of injury, which aspect of the tibial plafond will be fractured?
Medial aspect of the plafond.
400
This is the classification system discussed in McGlamry for evaluating soft tissue?
What is Tscherne and Gotzen? Grade 0 Closed Fracture: minimal soft tissue damage Grade I: significant abrasion or contusion Grade II: deep contaminated abrasion with local confusional damage to skin or muscle Grade III: Extensive confusion or crushing of skin or destruction of muscle, includes subcutaneous avulsions, decompensated compartment syndrome, or rupture of a major blood vessel.
400
In a polytrauma patient, what other imaging (besides foot and ankle) would you obtain?
AP of chest, pelvis, lateral cervical spine.
400
Why is it important to have successful reduction of the fibula?
- Restores proper length and rotation of the ankle - Key tibial component is usually attached to the fibula through soft tissue elements - Realignment of the fibula thus aids in tibial reconstruction.
400
What are some other complications of pilon fractures other than traumatic arthritis?
Loss of motion, prolonged edema, incisional scarring, skin necrosis, soft tissue or osseous infection, delayed union, non-union, implant failure, nerve entrapment, phlebitis, and malunion.
400
Put these in the correct order, according to the principles of open reduction for pilon fractures (Ruedi and Allgower, 1969): a) Reconstruction of the tibial articular surface b) Buttress plate application to the medial or anterior aspect of the tibia c) Cancellous bone graft to fill the distal tibial metaphyseal defect d) Reconstruction of the fibular fracture.
d, a, c, b
500
Name two other classification systems for pilon fractures?
Lauge-Hansen, Kellam and Waddell, Ovadia and Beals, AO Classification
500
What are some reasons initial stabilization of the fracture (closed reduction, modified compressing dressing/splint application) is important, according to McGlamry's?
Relief of pain, control of edema, surgery will be on a delayed basis (awaiting CT scan, soft tissue status, other injuries that may take precedence, unavailability of operating room, need to obtain medical clearance).
500
Why is a buttress plate used for the tibia, according to McGlamry's?
To prevent a late varus deformity.
500
Soft tissue trauma, extensive bony comminution, devascularized bony fragments, extensive dissection, long incisions, and prolonged operating time combine to increase the risk of what, according to McGlamry's?
What is infection?
500
According to McGlamry's, how many centimeters between incisions (for ORIF of the tibia and fibula) should there be to prevent necrosis?
7 cm
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