Tibial Pilon # - W

Question 1

Other name for tibial pilon # and what is it

Answer 1

• Plafond #
• Severe injuries affecting distal tibia
• Caused by high energy axial loads - tibia injured by talus pushing up on it

Question 2

Tibial pilon # characteristics

Answer 2

• Articular impaction
• Severe comminution
• Associated with soft tissue injury often
• = complex injuries

Question 3

Presentation tibial pilon #

Answer 3

• History trauma - eg high energy RTA or fall from height
• Severe ankle pain
• Inability to weight bear

Question 4

Examination of tibial pilon #

Answer 4

• Obvious deformity
• Significant swelling
• Skin blistering - fracture blisters
• CHECK FOR OPEN # and COMPARTMENT SYNDROME
• Check peripheral pulses and NV exam

Question 5

Classfication of tibial pilon #

Answer 5

Ruedi and Allgower classification
* Type 1 - undisplaced intrarticular #
* Type 2 - displaced intraarticular #
* Type 3 - comminuted/impacted #

Question 6

Investigations for tibial pilon #

Answer 6

• Major trauma - ATLS protocol eg A-E, treat life threatening injuries urgently etc
• Urgent bloods inc coagulation and group and save
• If pathological # - myeloma screen and calcium levels

Advanced trauma life support

Question 7

Imaging for tibial pilon #

Answer 7

• X-ray ankle - AP, lateral and mortise view
• Full length x-rays of tibia and knee too
• CT imaging often needed for pre-op planning

Question 8

Initial management tibial pilon #

Answer 8

• Reduce - realignment of limb
• Hold - Application of below knee backslab
• Repeat NV assessment and re-check x-rays
• Elevate limb and monitor for compartment syndrome
• Keep patient NBM with IV fluids for surgery

Question 9

Conservative management tibial pilon #?

Answer 9

• RARE to be simple undisplaced
• But these complex injuries are sometimes treated non-op if elderly or op is high risk
• But loss of reduction and malunion is common due to instability

Question 10

Surgical management tibial pilon # - aims

Answer 10

• Reconstruct articular surface
• Restore alignment
• Protect soft tissues around
• Usually done in staged approach esp if soft tissue swelling

Question 11

Surgical management of tibial pilon #

Answer 11

• Temporary spanning external fixator for 1st stage
• Definitive ORIF 7-14 days later once soft tissues healed
• Performed under traction (external fixator)
• In elderly or definitive management failed - can fuse with hindfoot nail

Question 12

Complications of tibial pilon #

Answer 12

• Compartment syndrome
• Wound infection
• Wound dehiscence
• Delayed or non-union
• Post traumatic arthiritis