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Pilon Fractures

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Orthopedic Traumatology

Abstract

JA is a 47-year-old male who presents to the emergency department with a chief complaint of right leg and ankle pain after falling 12 ft from a ladder and landing on his right leg. He denies pain in any other extremity or his back and is unable to bear any weight on his right lower extremity. On primary survey he demonstrates a GCS of 15, a patent airway, and is hemodynamically stable. On secondary survey, no gross deformity is noted of his right lower extremity.

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References

  1. Bourne RB, Rorabeck CH, Macnab J. Intra-articular fractures of the distal tibia: the pilon fracture. J Trauma. 1983;23(7):591–6.

    Article  PubMed  CAS  Google Scholar 

  2. Patillo D, Della Rocca GJ, Murtha YM, Crist BD. Pilon fracture complicated by compartment syndrome: a case report. J Orthop Trauma. 2010;24(6):e54–7.

    Article  PubMed  Google Scholar 

  3. Bone L, Stegemann P, McNamara K, Seibel R. External fixation of severely comminuted and open tibial pilon fractures. Clin Orthop Relat Res. 1993;292:101–7.

    PubMed  Google Scholar 

  4. Tornetta 3rd P, Weiner L, Bergman M, Watnik N, Steuer J, Kelley M, et al. Pilon fractures: treatment with combined internal and external fixation. J Orthop Trauma. 1993;7(6):489–96.

    Article  PubMed  Google Scholar 

  5. Helfet DL, Koval K, Pappas J, Sanders RW, DiPasquale T. Intraarticular “pilon” fracture of the tibia. Clin Orthop Relat Res. 1994;298:221–8.

    PubMed  Google Scholar 

  6. Pollak AN, McCarthy ML, Bess RS, Agel J, Swiontkowski MF. Outcomes after treatment of high-energy tibial plafond fractures. J Bone Joint Surg Am. 2003;85(10):1893–900.

    PubMed  Google Scholar 

  7. Collinge C, Kuper M, Larson K, Protzman R. Minimally invasive plating of high-energy metaphyseal distal tibia fractures. J Orthop Trauma. 2007;21(6):355–61.

    Article  PubMed  Google Scholar 

  8. Grose A, Gardner MJ, Hettrich C, Fishman F, Lorich DG, Asprinio DE, et al. Open reduction and internal fixation of tibial pilon fractures using a lateral approach. J Orthop Trauma. 2007;21(8):530–7.

    Article  PubMed  Google Scholar 

  9. Bacon S, Smith WR, Morgan SJ, Hasenboehler E, Philips G, Williams A, et al. A retrospective analysis of comminuted intra-articular fractures of the tibial plafond: open reduction and internal fixation versus external Ilizarov fixation. Injury. 2008;39(2):196–202.

    Article  PubMed  Google Scholar 

  10. Topliss CJ, Jackson M, Atkins RM. Anatomy of pilon fractures of the distal tibia. J Bone Joint Surg Br. 2005;87(5):692–7.

    Article  PubMed  CAS  Google Scholar 

  11. Tornetta 3rd P, Gorup J. Axial computed tomography of pilon fractures. Clin Orthop Relat Res. 1996;323:273–6.

    Article  PubMed  Google Scholar 

  12. Ruoff 3rd AC, Snider RK. Explosion fractures of the distal tibia with major articular involvement. J Trauma. 1971;11(10):866–73.

    Article  PubMed  Google Scholar 

  13. Jahna H, Wittich H, Hartenstein H. [Distal torsion fractures of the tibia. Results in 583 fresh cases]. Hefte Unfallheilkd. 1979;137:1–136.

    PubMed  CAS  Google Scholar 

  14. Ruedi TP, Allgower M. Fractures of the lower end of the tibia into the ankle-joint. Injury. 1969;1(2):92–9.

    Article  Google Scholar 

  15. Dillin L, Slabaugh P. Delayed wound healing, infection, and nonunion following open reduction and internal fixation of tibial plafond fractures. J Trauma. 1986;26(12):1116–9.

    Article  PubMed  CAS  Google Scholar 

  16. McFerran MA, Smith SW, Boulas HJ, Schwartz HS. Complications encountered in the treatment of pilon fractures. J Orthop Trauma. 1992;6(2):195–200.

    Article  PubMed  CAS  Google Scholar 

  17. Teeny SM, Wiss DA. Open reduction and internal fixation of tibial plafond fractures. Variables contributing to poor results and complications. Clin Orthop Relat Res. 1993;292:108–17.

    PubMed  Google Scholar 

  18. Wyrsch B, McFerran MA, McAndrew M, Limbird TJ, Harper MC, Johnson KD, et al. Operative treatment of fractures of the tibial plafond. A randomized, prospective study. J Bone Joint Surg Am. 1996;78(11):1646–57.

    PubMed  CAS  Google Scholar 

  19. White TO, Guy P, Cooke CJ, Kennedy SA, Droll KP, Blachut PA, et al. The results of early primary open reduction and internal fixation for treatment of OTA 43.C-type tibial pilon fractures: a cohort study. J Orthop Trauma. 2010;24(12):757–63.

    PubMed  Google Scholar 

  20. Sirkin M, Sanders R, DiPasquale T, Herscovici Jr D. A staged protocol for soft tissue management in the treatment of complex pilon fractures. J Orthop Trauma. 1999;13(2):78–84.

    Article  PubMed  CAS  Google Scholar 

  21. Patterson MJ, Cole JD. Two-staged delayed open reduction and internal fixation of severe pilon fractures. J Orthop Trauma. 1999;13(2):85–91.

    Article  PubMed  CAS  Google Scholar 

  22. Helfet DL, Shonnard PY, Levine D, Borrelli Jr J. Minimally invasive plate osteosynthesis of distal fractures of the tibia. Injury. 1997;28 Suppl 1:A42–7; discussion A7–8.

    Google Scholar 

  23. Mast JW, Spiegel PG, Pappas JN. Fractures of the tibial pilon. Clin Orthop Relat Res. 1988;230:68–82.

    PubMed  Google Scholar 

  24. Howard JL, Agel J, Barei DP, Benirschke SK, Nork SE. A prospective study evaluating incision placement and wound healing for tibial plafond fractures. J Orthop Trauma. 2008;22(5):299–305.

    Article  PubMed  Google Scholar 

  25. Boraiah S, Kemp TJ, Erwteman A, Lucas PA, Asprinio DE. Outcome following open reduction and internal fixation of open pilon fractures. J Bone Joint Surg Am. 2010;92(2):346–52.

    Article  PubMed  Google Scholar 

  26. Papadokostakis G, Kontakis G, Giannoudis P, Hadjipavlou A. External fixation devices in the treatment of fractures of the tibial plafond: a systematic review of the literature. J Bone Joint Surg Br. 2008;90(1):1–6.

    PubMed  CAS  Google Scholar 

  27. Assal M, Ray A, Stern R. The extensile approach for the operative treatment of high-energy pilon fractures: surgical technique and soft-tissue healing. J Orthop Trauma. 2007;21(3):198–206.

    Article  PubMed  Google Scholar 

  28. Chen L, O’Shea K, Early JS. The use of medial and lateral surgical approaches for the treatment of tibial plafond fractures. J Orthop Trauma. 2007;21(3):207–11.

    Article  PubMed  Google Scholar 

  29. Ovadia DN, Beals RK. Fractures of the tibial plafond. J Bone Joint Surg Am. 1986;68(4):543–51.

    PubMed  CAS  Google Scholar 

  30. Bahari S, Lenehan B, Khan H, McElwain JP. Minimally invasive percutaneous plate fixation of distal tibia fractures. Acta Orthop Belg. 2007;73(5):635–40.

    PubMed  Google Scholar 

  31. Borens O, Kloen P, Richmond J, Roederer G, Levine DS, Helfet DL. Minimally invasive treatment of pilon fractures with a low profile plate: preliminary results in 17 cases. Arch Orthop Trauma Surg. 2009;129(5):649–59.

    Article  PubMed  Google Scholar 

  32. Francois J, Vandeputte G, Verheyden F, Nelen G. Percutaneous plate fixation of fractures of the distal tibia. Acta Orthop Belg. 2004;70(2):148–54.

    PubMed  Google Scholar 

  33. Hazarika S, Chakravarthy J, Cooper J. Minimally invasive locking plate osteosynthesis for fractures of the distal tibia – results in 20 patients. Injury. 2006;37(9):877–87.

    Article  PubMed  CAS  Google Scholar 

  34. Leonard M, Magill P, Khayyat G. Minimally-invasive treatment of high velocity intra-articular fractures of the distal tibia. 2009;33(4):1149–53.

    CAS  Google Scholar 

  35. Redfern DJ, Syed SU, Davies SJ. Fractures of the distal tibia: minimally invasive plate osteosynthesis. Injury. 2004;35(6):615–20.

    Article  PubMed  CAS  Google Scholar 

  36. Salton HL, Rush S, Schuberth J. Tibial plafond fractures: limited incision reduction with percutaneous fixation. J Foot Ankle Surg. 2007;46(4):261–9.

    Article  PubMed  Google Scholar 

  37. Anglen JO. Early outcome of hybrid external fixation for fracture of the distal tibia. J Orthop Trauma. 1999;13(2):92–7.

    Article  PubMed  CAS  Google Scholar 

  38. Pugh KJ, Wolinsky PR, McAndrew MP, Johnson KD. Tibial pilon fractures: a comparison of treatment methods. J Trauma. 1999;47(5):937–41.

    Article  PubMed  CAS  Google Scholar 

  39. Watson JT, Moed BR, Karges DE, Cramer KE. Pilon fractures. Treatment protocol based on severity of soft tissue injury. Clin Orthop Relat Res. 2000;375:78–90.

    Article  PubMed  Google Scholar 

  40. Blauth M, Bastian L, Krettek C, Knop C, Evans S. Surgical options for the treatment of severe tibial pilon fractures: a study of three techniques. J Orthop Trauma. 2001;15(3):153–60.

    Article  PubMed  CAS  Google Scholar 

  41. Koulouvaris P, Stafylas K, Mitsionis G, Vekris M, Mavrodontidis A, Xenakis T. Long-term results of various therapy concepts in severe pilon fractures. Arch Orthop Trauma Surg. 2007;127(5):313–20.

    Article  PubMed  Google Scholar 

  42. Wang C, Li Y, Huang L, Wang M. Comparison of two-staged ORIF and limited internal fixation with external fixator for closed tibial plafond fractures. Arch Orthop Trauma Surg. 2010;130(10):1289–97.

    Article  PubMed  Google Scholar 

  43. Marsh JL, Buckwalter J, Gelberman R, Dirschl D, Olson S, Brown T, et al. Articular fractures: does an anatomic reduction really change the result? J Bone Joint Surg Am. 2002;84-A(7):1259–71.

    PubMed  CAS  Google Scholar 

  44. Anderson DD, Mosqueda T, Thomas T, Hermanson EL, Brown TD, Marsh JL. Quantifying tibial plafond fracture severity: absorbed energy and fragment displacement agree with clinical rank ordering. J Orthop Res. 2008;26(8):1046–52.

    Article  PubMed  Google Scholar 

  45. Li W, Anderson DD, Goldsworthy JK, Marsh JL, Brown TD. Patient-specific finite element analysis of chronic contact stress exposure after intraarticular fracture of the tibial plafond. J Orthop Res. 2008;26(8):1039–45.

    Article  PubMed  Google Scholar 

  46. McKinley TO, Borrelli Jr J, D’Lima DD, Furman BD, Giannoudis PV. Basic science of intra-articular fractures and posttraumatic osteoarthritis. J Orthop Trauma. 2010;24(9):567–70.

    Article  PubMed  Google Scholar 

  47. Ruedi T. Fractures of the lower end of the tibia into the ankle joint: results 9 years after open reduction and internal fixation. Injury. 1973;5(2):130–4.

    Article  PubMed  CAS  Google Scholar 

  48. Marsh JL, Weigel DP, Dirschl DR. Tibial plafond fractures. How do these ankles function over time? J Bone Joint Surg Am. 2003;85-A(2):287–95.

    PubMed  Google Scholar 

  49. Williams TM, Nepola JV, DeCoster TA, Hurwitz SR, Dirschl DR, Marsh JL. Factors affecting outcome in tibial plafond fractures. Clin Orthop Relat Res. 2004;423:93–8.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Orthopedics, Harborview Medical Center, University of Washington, 325 9th Avenue, Seattle, WA, 98104, USA

    David P. Barei M.D., F.R.C.S.(C)

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  1. David P. Barei M.D., F.R.C.S.(C)
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Correspondence to David P. Barei M.D., F.R.C.S.(C) .

Editor information

Editors and Affiliations

  1. Vanderbilt University School of Medicine, Division of Orthopedic Trauma, Vanderbilt University, MCE-South Tower Suite 4200, Nashville, 37232, Tennessee, USA

    Manish K. Sethi

  2. Vanderbilt University School of Medicine, Division of Orthopedic Trauma, Vanderbilt University, MCE-South Tower Suite 4200, Nashville, 37232, Tennessee, USA

    A. Alex Jahangir

  3. Vanderbilt University School of Medicine, Division of Orthopedic Trauma, Vanderbilt University Medical Center, MCE-South Tower Suite 4200, Nashville, 37232, Tennessee, USA

    William T. Obremskey

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Barei, D.P. (2013). Pilon Fractures. In: Sethi, M., Jahangir, A., Obremskey, W. (eds) Orthopedic Traumatology. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-3511-2_22

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  • DOI: https://doi.org/10.1007/978-1-4614-3511-2_22

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-3510-5

  • Online ISBN: 978-1-4614-3511-2

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