Minimally Invasive Plating of Pilon Fractures

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SAMPLE EXCERPT
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PRE-PROCEDURE
INDICATIONS
  • Distal tibial articular (pilon) fracture
  • Associated skin and soft-tissue injury
CONTRAINDICATIONS
  • Significantly poor bone stock
  • Preexisting osteomyelitis
  • Significant peripheral vascular disease
  • Inability to achieve and maintain fixation
  • Severely comminuted fracture in which articular surface cannot be restored
EQUIPMENT
  • Radiolucent operating table
  • Fluoroscopy unit
  • Femoral distractor
  • External fixator
  • Schanz pins
  • Olive wires
  • Plate/screw set (T-plate, cloverleaf plate, 4.5-mm dynamic compression plate, or one-half tubular plate)
  • Kirschner wires
  • Kelly clamp
  • Pointed probes
  • Suture (3-0 nylon, No. 5 Ethibond)
  • 4.0-mm cortical low-profile screws
  • Interfragmentary lag screws
  • Plaster splinting material
ANATOMY
  • The ankle mortise is formed proximally by the distal tibial articular surface and its medial malleolus and lateral malleolus of the distal fibula <(Figure 3)>.
  • The distal ankle joint is composed of the talus, which sits centered between the two malleoli.
  • The ankle pilon fracture by definition is a fracture of the dome of the distal tibial articular surface with metaphyseal extension. An associated fracture of the fibula may or may not be present. It is most commonly caused by an axial load that drives the talus up into the distal tibia.
  • Neurovascular structures can be at risk with any trauma to the ankle.
    • The primary blood supply here is provided by branches of the posterior tibia, peroneal, and dorsalis pedis arteries.
    • The saphenous nerve travels with the great saphenous vein just anterior to the medial malleolus.

PROCEDURE
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POST-PROCEDURE
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