1 / 21

FIBULAR FIXATION IN Pilon F RACTURE

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 ?

cian
Télécharger la présentation

FIBULAR FIXATION IN Pilon F RACTURE

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. FIBULAR FIXATION INPilon FRACTURE Chairiandi Siregar

  2. 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

  3. Fracture Personality • Open vs Close ? • Articular surface damage ? • Metaphysealcomminution ? • Diaphyseal involvement ? • Ipsilateral tibia or foot (talus)fracture?

  4. Fracture morphology: how many fragments ? • Anterior fraqment • Medial fragment • Posterior fragment • More fragment? • More comminution? • what about fibula?

  5. 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

  6. AO/OTA classification A : Extraarticular B : Partial Articular C : Complete intraarticular

  7. (Careful) Physical Examination • Vascular Injury • Swelling • Fracture Blisters • Blood filled • Clear filled • Patient comorbidites • Smoking • Diabetic and Peripheral Vascular Disease • Alcoholism

  8. 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

  9. 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 !!

  10. Normal Ankle Joint X-Ray • Tibiofibular overlap ~ 10mm • Tibiofibular clear space <5mm • Talar tilt

  11. Time is Important - When to operate ? • Close fx Tscherne grade ?? • Open fx  Gustilo grade?? DELAYED UNTIL SKIN WRINKLE SIGN is (+)

  12. 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

  13. 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

  14. 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

  15. The disadvantages of fibular fixation • Possible wound infection • Possible hardware removal • Malreduction of fibula will make the reduction of the tibia even harder

  16. Fibular Plating + Tibial Plating

  17. Fibular Intramedullary wiring + Tibial Plating

  18. Fibular Fixation + Tibia ExFix

  19. Ankle spanning exfix + Fibular Plating

  20. OLD AND NEW... THANK YOU

  21. DISCUSSION ?

More Related