pilon fractures or " plafond "
TRANSCRIPT
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Pilon FracturesPilon Fractures
Mohammed Nabil J AlAliMohammed Nabil J AlAli5th Year Medical StudentAt King Faisal University
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- OVERVIEW ( anatomy, definition, epidemiology and mechanisms )
- EVALUATION ( Clinical, physical and imaging )
- CLASSIFICATIONS- ASSOCIATED INJURIES- TREATMENT- COMPLICATIONS
Objectives
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ANATOMY
Talus
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ANATOMY
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What is Pilon Fracture?• Pilon is a French word for pestle ( also known as
Plafond Fracture ) .
• It is intraarticular fracture of the distal end of the tibia , involving the disruption of the distal tibial weight-bearing articular surface .
• It is different from ankle fractures .• In most cases, both bones are broken .
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EPIDEMIOLOGYEPIDEMIOLOGY• Account for approximately 5-7% of all tibia fractures.• But less than 1% of all lower-extremity fractures .• More commonly at average age of 35 to 40 years old.
rare in children and elderly.
• Commonly in men than women (3:1)• Because of the energy required to cause this type of
fracture, 25% to 50% of patients have additional injuries that require treatment.
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Mechanism Pilon fractures are most often caused by axial loading (high-
energy impacts or combination), such as : Fall from height , Motor-vehicle accident .
- Leads to ( high degree of disruption of articular surface and soft tissue affection )
It may be caused by shear loading (rotational or lower-energy impacts ) such as : Ski accident .
- Leads to ( less degree of disruption of articular surface )
Often affects both bones of the lower leg.
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EVALUATIONEVALUATION
Clinical presentation
Physical examination
Imaging
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• Signs and symptoms include an inability to bear weight , marked pain , marked
swelling , and evidence of soft tissue injury and deformity ( out of place ) .
Clinical presentation
EEVVAALLUUAATTIIOONN
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Physical examination
• Neurovascular examination include distal pulses , capillary refill , motor and sensory examination .
• Soft tissue- Closed fractures : classified using the method of Tscherne- Opened fractures : classified using the method of Gustilo .
EEVVAALLUUAATTIIOONN
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Imaging
EEVVAALLUUAATTIIOONN
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EEVVAALLUUAATTIIOONN
Imaging
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CLASSIFICATIONS
Association for Osteosynthesis/Orthopedic trauma association (AO/OTA) Classification
Reudi and Allgower Classification
Has good interobserver and intraobserver agreement at the type level .
Has good interobserver and intraobserver agreement at the group level
(the most important ).
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Type I Fracture involving minimal displacement
Type II Significant displacement of the joint surface
Type III Impaction and comminution of the articular surface
CLASSIFICATIONS
Reudi and Allgower Classification
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CLASSIFICATIONS
AO/OTA Classification
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ASSOCIATED INJURIES
• Other skeletal injuries
• Soft tissue injuries- open fractures
- closed fractures
• Neurovascular injuries
• Other body parts injuries
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TREATMENT and RATIONAl
Treatment goals Treatment options Bony considerations soft tissue considerations Timing of surgery
TREATMENT
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TREATMENT
Surgical( To manage displaced
fractures )
Modern methods : (ORIF) and external
fixation with or without limited internal fixation
Treatment goals - Anatomical restoration of distal tibial articular surface .- Early ankle range of motion.
Treatment options
Non-surgical( to manage
non-displaced fractures)
Cast and Splints
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Bony considerationsTibia
- Comminution - Lower energy : (ORIF)
- High energy + large number of small articulations :
external fixation with or
without limited internal fixation
- Diaphyseal extention
Typically epi and meta of fracture is heal more rapid .
Fibula
ORIF with plate and scrow
Remember the most important is restore Tibia
TREATMENT
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soft tissue considerations
Timing of surgeryDepend on soft tissue affection .
Low-energy injuries :
By ORIF
TREATMENT
High-energy injuries :
By external fixation with or without limited internal fixation
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Plates and screws An external fixatorA splint
TREATMENT
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ANATOMICAL CONSEDARATIONS AND SURGICAL TECHNIQUES
• ORIF• External fixation - Unilateral
- ilizarvo ( consists of fine wire “ 1.8mm” for interfragmentary fixation ) .
- hybird ( ring with wire distally )
• Soft tissue • LigamentotaxisWhen traction is applied across the ankle joint , the intraarticular
fragments may be reduced by pull of the capsule and ligamentous structures .
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COMPLICATIONS
• Soft tissue slough. • Infections .• Neurovascular injuries.• Bone healing problems
( Mal-alignment, Mal-union and Non-union ) .• Painful plates and screws.• Decreased ankle joint range of motion.• Chronic edema .• Posttraumatic arthritis .
Sever complications following ORIF of tibial fractures range from 10-55% and some can lead to amputation
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Any Question ?Any Question ?
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REFERENCES- Review of Orthopaedic
Trauma by Mark R.Brinker , M.D.
- AAOS (press on the title )
- Medescape (press on the title )
- UpToDate (press on the title )
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Thank you