Pilon fracture

Top PDF Pilon fracture:

<p>Pilon Fractures: Challenges and Solutions</p>

<p>Pilon Fractures: Challenges and Solutions</p>

Preoperative planning begins with a thorough evaluation of the patient ’ s co-morbidities, functional and social status. Factors such as sex, lower socioeconomic status, laborers, and work-related injuries portend poorer outcomes. Next, a thorough evaluation of the imaging obtained to de fi ne the diagnosis and develop a treatment approach. Traction radiographs can provide a simple adjunct to injury fi lms in a patient too unstable for advanced imaging. General restoration of the length, rotation, and axial alignment may help delineate the true fracture pattern, fragments, and range of reduction. Computed tomography (CT) pro- vides a more detailed evaluation of the articular segments and most would agree is imperative for surgical planning. Advantages of obtaining a CT scan after external fi xation or preliminary reduction and immobilization include an accurate illustration of the fracture pattern, mobility of the fragments, limit radiation exposure and cost but also as this new information may change the approach com- pared to a CT done prior to preliminary stabilization (Figure 1A – E). 36,37 The most common fracture pattern usually splits the articular surface into three variable yet predictable fragments: the medial fragment consisting of the medial malleolus and adjacent weight-bearing seg- ment, the anterolateral or Chaput fragment, and the poster- olateral or Volkman fragment usually with their ligamentous attachments intact. 38 The location of where these fracture lines exit the cortex, position of articular segments, and if those fragments lie in continuity with the intact tibial shaft dictate the location of implant placement and subsequently the surgical approach(es) used. In addi- tion to the boney injury, it is important to identify the soft tissue components, usually with a “ soft tissue window ” on CT, to detect interposition of vital structures or evidence of prior surgery/injury that may dictate changes in the opera- tive plan. There is a limited role for MRI in the acute setting of pilon fractures.
Show more

9 Read more

Clinical application of arthroscopy-assisted minimally invasive therapy in Chinese elderly with type III Pilon fracture

Clinical application of arthroscopy-assisted minimally invasive therapy in Chinese elderly with type III Pilon fracture

To our knowledge, very few studies have specifically compared the clinical value of arthroscopy-assisted mini- mally invasive therapy and EFLIF in Chinese elderly with type III Pilon fracture. It is very necessary to determine an optimal choice of surgical therapy in Chinese elderly with type III Pilon fracture. The current study showed that com- pared with EFLIF, arthroscopy-assisted minimally invasive therapy achieved a better reduction result, bone union and functional status, supporting that it is more effective than EFLIF in Chinese elderly with type III Pilon fracture. Mean- while, as to the complications of surgical therapy for Pilon fracture, infection has been reported to be the most common, and its increased prevalence might be caused by high-energy injury of Pilon fracture. 26 Additionally, traumatic arthritis is
Show more

6 Read more

Advantages of Ilizarov External Fixation in an Elderly Patient with Pilon Fracture with Severe Soft Tissue Injury and Severe Osteoporosis: A Case Report

Advantages of Ilizarov External Fixation in an Elderly Patient with Pilon Fracture with Severe Soft Tissue Injury and Severe Osteoporosis: A Case Report

Introduction: Pilon fracture in elderly individuals is characterized by senile skin atrophy, poor dermal extensibility, and thin subcutaneous tissue. The use of bulky internal fixation material can thus cause the swelling that accompa- nies the fracture to induce secondary injury to skin tissue. In addition, initia- tion of postoperative weight-bearing is delayed due to bone fragility and dif- ficulties with partial weight-bearing, causing a tendency toward prolonged hospitalization. Mean duration of hospitalization after pilon fracture for el- derly patients in our department was 79.2 days. Case Presentation: An 80-year-old woman with pilon fracture with soft tissue injury and severe os- teoporosis was transferred to our department. The fracture was treated using Ilizarov external fixation. Fourteen days postoperatively, walking with full weight-bearing was permitted. The hospital stay was 28 days. The external fixator of the ankle was removed 87 days postoperatively, at which time the patient was anatomically and functionally recovered and able to walk unaided. Conclusion: Ilizarov external fixation may represent a useful option in elderly patients with pilon fracture showing severe soft tissue injury and severe os- teoporosis. The present case provides evidence that this procedure can be suc- cessfully applied to the management of such pilon fractures in elderly patients.
Show more

9 Read more

Efficacy and safety of 3D print-assisted surgery for the treatment of pilon fractures: a meta-analysis of randomized controlled trials

Efficacy and safety of 3D print-assisted surgery for the treatment of pilon fractures: a meta-analysis of randomized controlled trials

restore the length and alignment, allowing for earlier weight bearing and functional exercise [20]. Orthope- dists usually formulate surgical plans based on X-ray, CT, or other examination outcomes with conventional surgery [21]. However, pilon fractures are severely com- minuted fractures, and the ankle joints are often accom- panied by severe collapse and loss of bone. Conventional imaging outcomes cannot directly display the specific shape of the fracture, and even sometimes omit occult fractures. The surgeon continues surgery based on clin- ical experience when the intraoperative condition is not consistent with the expected situation during surgery, which possibly leads to change of the surgical plan, pro- long the operation time, increase the blood loss, aggra- vate the soft tissue injury, and even cause the failure of the operation. Therefore, it is critical for surgeons to perform a pre-surgery based on 3D printing model. They can predict the problems that may be encountered dur- ing the operation, such as the optimal surgical approach, matched implant. Therefore, this surgical method shortens the operation time and improves the effects of surgery [22]. In addition, the surgeon can adequately communicate with patients using this vivid fracture model [23].
Show more

9 Read more

Analysis of functional outcome of anterolateral plating in tibial pilon fractures

Analysis of functional outcome of anterolateral plating in tibial pilon fractures

Locking compression plating (LCP) is the most widely used implant for tibial pilon fractures at present. It can be performed by minimally invasive technique or standard open reduction and internal fixation methods. These are anatomically contoured to the bone surface to which it is applied. For pilon fracture the gold standard was medial LCP, a low profile plate placed through medial approach. The low profile nature tends to address the problem of bulky implant used in standard AO plating techniques. Medial plating using LCP on the subcutaneous medial border of distal tibia still resulted in a significant rate of wound dehiscence and deep infection, although at a lower rate compared to standard AO plates.
Show more

140 Read more

Advantages of the Ilizarov external fixation in the management of intra-articular fractures of the distal tibia

Advantages of the Ilizarov external fixation in the management of intra-articular fractures of the distal tibia

The Ilizarov device consisted of 2 proximal rings placed at the distal half of the tibia and a foot plate. 1.8 mm olive wires have been used for the reduction and fixation of the major bone fragments and were properly connected to the rings. (Figure 2) Four major bone fragments were identi- fied in this series of Pilon fractures. (Figure 3) The lateral fragment which consist an avulsion fracture of the tibi- ofibular syndesmosis, the medial fragment which includes the medial maleollus, the posterior fragment consisting of the posterior maleollus and the anterior frag- ment on which the anterior articular capsule inserts. With the Ilizarov device the fracture site is distracted and through ligamentotaxis the smaller bone fragments can be reduced and remain stable. Additionally, through the Ili- zarov device the alignment of the limb is controlled, avoiding valgus or varus deformities. (Figure 4) Accuracy of reduction is controlled by image intensifier. No bone grafts were used. Early mobilization started 4-6 weeks postoperatively with the use of hinges at the ankle joint. AO principles were followed in fractures which were treated with unilateral external fixators including fixation of the fibula, anatomic reduction of the articular surface,
Show more

7 Read more

Modified posteromedial approach for treatment of posterior pilon variant fracture

Modified posteromedial approach for treatment of posterior pilon variant fracture

Unlike classic pilon fractures, about 8 days’ waiting period for soft tissue resolution in Chen’s and in this study [14] both indicate that posterior pilon variant is not from high energy trauma that requires staged man- agement in pilon fracture [20, 21]. Besides, the coronal fracture lines found in posterior pilon variant was differ- ent from sagittal fracture lines in high energy pilon frac- ture described by Topliss et al. [22]. On the contrary, the fracture lines were consistent with the fracture map of posterior malleolus [3, 4]. What’s more, unlike mal- leolar fracture caused by low energy torsional force, the independent PM fracture in posterior pilon variant not only extends proximally but also often involves posterior
Show more

8 Read more

Management of extra-articular distal tibial fractures with combined external fixation and limited internal fixation: A prospective study

Management of extra-articular distal tibial fractures with combined external fixation and limited internal fixation: A prospective study

In the external fixation group, two patients (10%) developed a deep infection, one patient (5%) had a loss of reduction, one patient (5%) had an injury to the posterior tibial nerve, and four patients (20%) healed in malalignment. Articular reduction was better in the open reduction and internal fixation group; however, there were no type III fractures in the external fixation group. The authors concluded that external fixation was a satisfactory method of treatment for tibial pilon fractures and had fewer complications than open reduction and internal fixation. Watson et al. also reported more excellent and good results at 5-year follow-up with external fixation (81%) than with open plating (75%) in 94 pilon fractures. They based their treatment choices on the severity of the soft-tissue injury: Tscherne grade 0 and grade I were treated with plating, and grade II and grade III and open fractures were treated with external fixation.
Show more

62 Read more

A case study of distal tibial fractures managed with locking compression plate using MIPO technique

A case study of distal tibial fractures managed with locking compression plate using MIPO technique

Ruedi and Allgower 52 were the pioneers in open reduction and internal fixation (ORIF) of pilon fractures. They changed the outlook of management of distal tibia fractures in the early twentieth century. They achieved 74% good functional results following ORIF for distal tibia fractures. But it was later recognized that all their cases were results of low velocity injuries. 53,54 They could not reproduce similar results following the principles of open reduction internal fixation in high velocity injuries 55 .

144 Read more

Experimental investigations of the influence of material and thickness on fracture under pure mode II loading

Experimental investigations of the influence of material and thickness on fracture under pure mode II loading

II fracture were performed. Tension-shear specimens made of aluminium alloy LC4CS and 7050-T7452 with thicknesses of 2, 4, 8 and 14 mm were used. All crack tip appearances and fracture profiles of the specimens were observed. Mode II fracture toughness were calculated. It is shown that material and thickness play an important role in mode II fracture. The fracture of LC4CS appears shear fracture under all kinds of thicknesses, however the fracture of 7050-T7452 is tensile fracture when thickness is larger or equal to 8mm, and shear initiation along the original crack plane, then turnaround and tensile failure when thickness is smaller than 8mm. Mode II fracture toughness is independent of thickness.
Show more

6 Read more

Biomechanical evaluation of fracture construct for fracture fixation of the tibia

Biomechanical evaluation of fracture construct for fracture fixation of the tibia

fracture fixation using a plate and screws as the fixation devices and it also one of the direct method for fracture fixation. The implant will hold the fracture site by maintaining the fracture bones align together in their anatomical place until the bone heal itself. After healing process is complete without any complication, the implant will be leave in the patient body unless there is some complication cause by the implant to the patient. The whole fixation process from identifying the problem until the bone is fully heal need to be done under two separated surgical procedure. Between both surgical procedures, the stability of the implant and the expertise of the surgeon will be tested by the reaction the patient’s body with the implant [7]. Stability of the fracture construct is the main aspect that needs to be considers during fracture fixation. The implant need to be able to maintain the fracture construct and endure all physical activity that being done by the patient during healing period of the bone. achieving stable fixation may become a step closer to the fracture fixation common goal which is to achieve boney union [8].
Show more

33 Read more

Femoral Neck Fracture in a Three-Year-Old Child; Case Report

Femoral Neck Fracture in a Three-Year-Old Child; Case Report

Femoral neck fracture is a rare that accounts for less than 1% of all childhood fractures (1, 2). Compared to the elderly who would have a hip fracture due to osteoporosis in a minor fall, 90% of children need to be exposed to severe trauma such as motor vehicle accidents and falling from high altitude crash a fracture due to their high bone mineral density(2, 3). The Delbet classification system (1907) is the most common system for describing femoral neck fractures in children, later modified by Colonna (1929)(1, 4). The type I is transphyseal fracture, the second type is transcervical fracture (the most common type), the third type is cervicotrochanteric fracture, and the fourth type is extracapsular, intertrochanteric fractures. These fractures are also divided into two types of with and without displacement(5).
Show more

9 Read more

Implant Failure - Prosthodontist’s Eye View

Implant Failure - Prosthodontist’s Eye View

• Improper fit of the abutments and the fixture can create constant tension and lead to abutment screw loosening or fracture. Greater the stress applied to the prosthesis, greater the risk of abutment screw loosening. Cantilevers also increase the risk of abutment screw loosening, as they increase the forces in direct relationship to the length of the cantilever. Greater the crown height attached to the abutment, greater

6 Read more

Floating Knee Injuries: An analysis of functional outcome and factors influencing the outcome

Floating Knee Injuries: An analysis of functional outcome and factors influencing the outcome

Twenty two patients had fourty six associated injuries and eighteen (51.4%) of them had ipsilateral injuries (fracture patella was seen in seven (20%) patients). Three patients (8.5%) had an associated vascular injury, two of them underwent an above knee amputation and the third patient underwent thrombectomy and stabilization fractures with an external fixator. There were four patients with contralateral lower limb injuries, two had tibial and two had open tibial fractures. Other system injuries were seen in twelve patients who included three patients with clavicle fractures and two patients with rib fractures. Anterior Cruciate Ligament laxity was seen in six patients (17.1%) and Posterior Cruciate Ligament laxity was seen in two (5.7%) patients. The incidence of associated ligamentous injuries varies from 2- 39% (Schiedts et al 25 ), of the eight patients
Show more

98 Read more

A Rare Case of Fracture of Radius Associated with Dislocation of Both Distal and Proximal Radio Ulnar Joint

A Rare Case of Fracture of Radius Associated with Dislocation of Both Distal and Proximal Radio Ulnar Joint

This particular case also may be due to fall on outstretched hand but with considerable axial force and the ex- act rotational position of the forearm is uncertain. The elbow might sustain some varus force combined with ro- tation causing radial head to dislocate from its position. It was also associated with gross injury to interosseous membrane. This was assumed from the gross swelling of the forearm from proximal to the distal end and later confirmed during open reduction of the fracture.

7 Read more

Incidence of Clavicular Fractures and Its Management in Northern Ghana

Incidence of Clavicular Fractures and Its Management in Northern Ghana

desire results are not achieve. Fractures of the clavicle has been in the sphere of nonoperative treatment for a long time but recent studies have shown that the rate of mal- union or nonunion after nonoperative treatment might well be much higher than previously shown especially among young adults [10]. In this part of the world clavicular fractures like other fractures are usually managed using the Figure-of-eight or by traditional bonesetters. This practice could be accountable for the high number of mal-union or nonunion reported in the present study as old cases. The old cases were all due to malunion and nonunion leading to unsatisfactory functional results. The question therefore arises as to the relevance of the traditional figure-of-eight for management of clavicular fracture in this part of the world where majority of the fractures are displaced and comminuted which are compounded by mishandling either at the accident site or during transport from the accident site to the health institution due to non availability of the Ambulance system. In addition there have been newer operative techniques with minimal invasion and with better recovery time and functional outcomes compare to the traditional figure-of-eight as has been shown by other studies [14, 15]. It is the view of the authors that operative management of clavicular fractures in this part of the world may be the way to go since patients who underwent management by both the traditional figure-of-eight and the Traditional bonesetter methods presented with unsatisfactory functional outcomes whereas all the cases that were managed operatively had good functional outcomes without any complications.
Show more

7 Read more

Study of Concrete under the Action of Hydraulic fracturing in Ⅰ - Ⅱ mixed mode fracture criterion

Study of Concrete under the Action of Hydraulic fracturing in Ⅰ - Ⅱ mixed mode fracture criterion

Double-K fracture theory as the whole process can be divided into crack initiation, crack propagation and crack instability. Application of the theory of double-K fracture is the key to the whole process of fracture to determine the crack point and instability point. A lot of trials found that the fracture process of crack initiation point is the P-CMOD curve rises linear to nonlinear phase transition point; instability point is the point of peak load in the curve.

11 Read more

A study on blunt injury to the eye and its management

A study on blunt injury to the eye and its management

Floor fracture with visual loss indicates injury to the optic nerve or increased orbital pressure causing a compartment syndrome. It is diagnosed with CT scan orbit with coronal and sagittal view. Majority of blow out fractures does not require surgical intervention. It is usually observed for 7 – 10 days to allow the swelling and orbital hemorrhage to subside. Oral prednisolone 1mg / kg / day for 7 days decrease the oedema and limit the risk of long term diplopia from inferior rectus contracture and fibrosis.

81 Read more

The loss of bone mineral with aging and its relationship to risk of fracture

The loss of bone mineral with aging and its relationship to risk of fracture

Midshaft mass adjusted to width 1.25 cm Total 32 Number with fracture 7 Percent with fracture 22% Distal mass Total 39 Number with fracture 7 Percent with fracture 18% Distal mass adjust[r]

9 Read more

Open pelvic fracture: the killing fracture?

Open pelvic fracture: the killing fracture?

Pelvic fractures are often caused by high-energy trauma, and these patients often have multiple injuries. Open pelvic fractures are rare, with an estimated incidence of 2–4% of all pelvic fractures [1]. Open pelvic fractures are character- ized by direct communication between the fracture hematoma and the external environment (through the rec- tum, vagina, or skin). Patients are at risk for early exsan- guination because massive hemorrhage can occur due to disruption of the natural anatomic compartment and loss of the tamponade effect (Fig. 1). Late mortality is caused by pelvic sepsis and multiple organ failure [2]. Historically, mortality rates up to 50% were reported in the 1970s [3], which was considerably higher than the mortality rates re- ported for closed fractures in the same period [4]. In the 1990s, there was an improvement in treating these injuries. Leenen et al. [5] reported a mean ISS of 48 and mortality
Show more

8 Read more

Show all 3886 documents...