3/20/2023 0 Comments Pilon fractureUnder the Ruedi-Allgower classification system, healthcare providers categorize pilon fractures as the following types: There are several types of pilon fractures depending on the pattern of the break, and there are many classification systems to describe them. What are the different types of pilon fractures? Pilon fractures happen when your talus is driven into your tibia with such force that your tibia (and often your fibula as well) breaks at your ankle joint. Your tibia and fibula are attached to your talus, which is the weight-bearing bone in your ankle. This type of bone break is called a pilon fracture because of the crushing force that often causes them. “Pilon” is the French word for pestle, which is a tool with a rounded end that’s used to crush and grind substances. Most cases of pilon fractures are caused by high-impact events, such as a vehicle accident or falling from a significant height. In many cases of pilon fractures, the other bone in your lower leg, your fibula, is broken as well. The four-column classification can be summarized as lateral column (the distal fibula), posterior column (the posterior part of the intermalleolar line with the distal tibial shaft), anterior column (the anterior part of the intermalleolar line with the distal tibial shaft) and medial column (the medial one-third of the tibial plafond with the distal tibial shaft) Till now, there's no randomized prospective controlled trials confirmed which method either two-stage open reduction and internal fixation or single-stage external fixation is superior regarding clinical, radiological, and functional outcomes.A pilon fracture is a relatively rare bone break that happens at the bottom of your tibia (the larger of the two bones in your lower leg, or your shinbone) near your ankle. The CT based four-column classification has been adopted by many surgeons as a guide for the treatment of comminuted pilon fractures. However, other surgeons have recommended limited internal fixation combined with external fixation for these severe fractures as an alternative to open reduction and internal fixation to reduce the risk of postoperative complications. This technique focuses on the soft tissue condition and potentially decreases the incidence of soft tissue complications.Thus, this method is widely considered the standard of care for high-energy pilon fractures. Two-stage open reduction and internal fixation involves closed reduction and external fixation followed by conversion to open reduction and internal fixation after the condition of the surrounding soft tissues has improved. With the accumulation of surgical experience and the development of surgical techniques, two-stage open reduction and internal fixation and limited internal fixation combined with external fixation were established, and these two methods are now widely advocated for the treatment of comminuted tibial pilon fractures. Therefore, orthopaedic surgeons made great efforts to establish methods that provided good results and decreased postoperative complications. These complications arose from the internal fixation, leading many orthopaedic surgeons to choose external fixation as an alternative.Īlthough external fixation decreased wound necrosis and skin sloughing, high rates of pin site infection and malalignment with subsequent non-union occurred. In 1979, Ruedi and Allgower first reported satisfactory results with primary open reduction and internal fixation.However, many authors have noted significant complications when open reduction and internal fixation was applied to severe pilon fractures, including an infection rate as high as 55%, wound necrosis and skin sloughing. Several methods have been advocated to manage complex pilon fractures, but an optimal fixation technique remains controversial. Optimal treatment of comminuted pilon fractures requires precise anatomical reduction accompanied by early functional exercise. Most complex pilon fractures are associated with severe soft tissue injuries, making the treatment challenging. However, with the high incidence of high energy trauma and accidental falls, the number of comminuted fractures has increased in recent years.Among all pilon fractures, about 30% are complex pilon fractures (AO/ OTA 43C type) caused by high-energy injuries. A pilon fracture ( also known as tibial plafond fractures) is a fracture of the distal end of the tibia with comminution, intra-articular extension and significant soft tissue injury.Pilon injury accounts for about 5% to 10% of all tibial fractures, and for <10% of lower extremity injuries.
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