Tibial Pilon # - W Flashcards

1
Q

Other name for tibial pilon # and what is it

A
  • Plafond #
  • Severe injuries affecting distal tibia
  • Caused by high energy axial loads - tibia injured by talus pushing up on it
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2
Q

Tibial pilon # characteristics

A
  • Articular impaction
  • Severe comminution
  • Associated with soft tissue injury often
  • = complex injuries
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3
Q

Presentation tibial pilon #

A
  • History trauma - eg high energy RTA or fall from height
  • Severe ankle pain
  • Inability to weight bear
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4
Q

Examination of tibial pilon #

A
  • Obvious deformity
  • Significant swelling
  • Skin blistering - fracture blisters
  • CHECK FOR OPEN # and COMPARTMENT SYNDROME
  • Check peripheral pulses and NV exam
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5
Q

Classfication of tibial pilon #

A

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

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6
Q

Investigations for tibial pilon #

A
  • 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

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7
Q

Imaging for tibial pilon #

A
  • 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
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8
Q

Initial management tibial pilon #

A
  • 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
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9
Q

Conservative management tibial pilon #?

A
  • 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
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10
Q

Surgical management tibial pilon # - aims

A
  • Reconstruct articular surface
  • Restore alignment
  • Protect soft tissues around
  • Usually done in staged approach esp if soft tissue swelling
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11
Q

Surgical management of tibial pilon #

A
  • 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
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12
Q

Complications of tibial pilon #

A
  • Compartment syndrome
  • Wound infection
  • Wound dehiscence
  • Delayed or non-union
  • Post traumatic arthiritis
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13
Q
A
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