Tibial Plafond Fractures

Question 1

What are the 3 typical fragments in a plafond fractures?

Answer 1

1) Volkman (posterolateral)
2) Chaput (anterolateral)
3) medial malleolus

Question 2

What are parameters that are a/w poorer outcomes in pilon fractures?

Answer 2

1) lower level of education
2) pre-existing medical comorbidities
3) male sex
4) work-related injuries
5) lower income levels

Question 3

What are the three branches of the popliteal artery and where do they lie?

Answer 3

1) Anterior tibial: first branch, lies anterior to IOM btw tib ant and EHL; terminates as dorsalis pedis
2) Posterior tibial: in deep posterior compartment, terminates as medial/lateral plantar arteries
3) Peroneal: in deep posterior compartment btw tibialis posterior and FHL; terminates as calcaneal br

Question 4

What is the initial treatment for most pilon fractures?

Answer 4

Spanning external fixator

Leave in place for 10-14 days

Question 5

When does brake time return to normal following ORIF of pilons?

Answer 5

6 weeks after weight bearing

Question 6

What are the ligamentous attachments of the 3 main fragments in a pilon injury?

Answer 6

Chaput- AITFL
Volkman- PITFL
Medial malleolus- deltoid lig

Question 7

Pilon fractures can be addressed with many approachs, what length of skin bridge is important?

Answer 7

>7cm
direct anterior approach to ankle 
anterolateral approach to ankle 
anteromedial approach to ankle 
medial approach
posteromedial approach 
posterolateral approach
lateral approach

Question 8

What are the key steps for ORIF of pilon injuries?

Answer 8

1) anatomic reduction of articular surface
2) restore length
3) reconstruct metaphyseal shell
4) bone graft
5) reattach metaphysis to diaphysis

Fibula can be fixed first if simple fx pattern, if communited tibia can be reduced and pinned then fibula fixed

Question 9

What is the incidence of wound complications in pilon injuries?

Answer 9

Wound slough- 10%

Dehiscence- 9-30%