fibular fixation in pilon f racture
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FIBULAR FIXATION IN Pilon F RACTURE. Chairiandi Siregar . Mechanism of Injury. Low Energy (Rotational Force) High Energy (Axial Loading) Motor Vehicle Coalition Fall from height Incidence of fibular fx is 85% of all pilon fx. Fracture Personality . Open vs Close ?

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Presentation Transcript
mechanism of injury
Mechanism of Injury
  • Low Energy (Rotational Force)
  • High Energy (Axial Loading)
    • Motor Vehicle Coalition
    • Fall from height
  • Incidence of fibular fx is 85%

of all pilon fx

fracture personality
Fracture Personality
  • Open vs Close ?
  • Articular surface damage ?
  • Metaphysealcomminution ?
  • Diaphyseal involvement ?
  • Ipsilateral tibia or foot (talus)fracture?
fracture morphology how many fragments
Fracture morphology: how many fragments ?
  • Anterior fraqment
  • Medial fragment
  • Posterior fragment
  • More fragment?
  • More comminution?
  • what about fibula?
ruedi allgower classification
Ruedi-Allgower classification

I

II

III

  • Grade I
    • Minimal displacement
    • No severe joint injury
  • Grade II
    • Moderate displacement
    • Minimal comminution
  • Grade III
    • Comminution and impaction
ao ota classification
AO/OTA classification

A : Extraarticular

B : Partial Articular

C : Complete intraarticular

careful physical examination
(Careful) Physical Examination
  • Vascular Injury
  • Swelling
  • Fracture Blisters
    • Blood filled
    • Clear filled
  • Patient comorbidites
    • Smoking
    • Diabetic and Peripheral Vascular Disease
    • Alcoholism
treatment options
Treatment Options
  • Plaster
  • Traction (Calcaneal)
  • ORIF Plate & Screw (Ruedi & Allgower1969)
  • 2 stage (Fibular plating + ankle spanning exfix followed by ORIF in the next 2 or 3 weeks; Patterson)
  • Definitive external fixation
  • Primary arthrodesis
goal in pilon fx treatment
Goal in PilonFx Treatment
  • Restoring Anatomical Surface
  • Restoring Mechanical Alignment
  • Maintaining Joint Stability
  • Achieving fracture union
  • Regaining functional and pain-free weight bearing
  • Avoiding complication

FUNCTIONAL

OUTCOME !!

normal ankle joint x ray
Normal Ankle Joint X-Ray
  • Tibiofibular overlap ~ 10mm
  • Tibiofibular clear space <5mm
  • Talar tilt
time is important when to operate
Time is Important - When to operate ?
  • Close fx Tscherne grade ??
  • Open fx  Gustilo grade??

DELAYED UNTIL SKIN WRINKLE SIGN is (+)

factors involving outcome
Factors involving outcome

The Injury

  • Articular damage
  • Metaphysealcomminution
  • Diaphysealinvolvment
  • Soft tissu compromise
  • Medical comorbidities
  • Fibular fixation ??

The Surgeon

  • Atraumatic handling
  • Proper implant
  • Time of surgery
fixation of the fibula
Fixation of The Fibula
  • Study design
    • 98 pilon fractures
    • Group A : ORIF Fibular Plating (n=50)
    • Group B : ORIF Pin fixation (n=23)
    • Group C : Treated conservatively (25)
  • Result
    • Decrease trend of malunion and ankle arthrosis
    • Better clinical outcome
    • FIBULAR FIXATION IS IMPORTANT

Lee YS, et al. Stabilisation of the fractured fibula plays an important role in the treatment of pilon fractures: a retrospective comparison of fibular fixation methods. International Orthopaedics (SICOT) (2009) 33:695-699

the advantage of fibular reduction and fixation
The advantage of fibular reduction and fixation
  • Increasing mechanical stability
  • Assissting the reduction of anterolateral articular fragment
  • Restoring the length and alignment of the tibia
  • Reduces the ankle ‘mortise’
  • Prevent lateral shift of the talus
the disadvantages of fibular fixation
The disadvantages of fibular fixation
  • Possible wound infection
  • Possible hardware removal
  • Malreduction of fibula will make the reduction of the tibia even harder
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