Book contents
- Frontmatter
- Dedication
- Contents
- List of contributors
- Preface
- Acknowledgments
- Part I Upper extremity
- Part II Pelvis and acetabulum
- Part III Lower extremity
- Chapter 9
- Chapter 10
- Chapter 11
- Chapter 12
- Section I Fractures of the proximal tibia
- Section II Fractures of the tibial shaft
- Section III Fractures of the distal tibia
- Chapter 13
- Chapter 14
- Part IV Spine
- Part V Tendon injuries
- Part VI Compartments
- References
- Index
Section III - Fractures of the distal tibia
from Chapter 12
Published online by Cambridge University Press: 05 February 2015
- Frontmatter
- Dedication
- Contents
- List of contributors
- Preface
- Acknowledgments
- Part I Upper extremity
- Part II Pelvis and acetabulum
- Part III Lower extremity
- Chapter 9
- Chapter 10
- Chapter 11
- Chapter 12
- Section I Fractures of the proximal tibia
- Section II Fractures of the tibial shaft
- Section III Fractures of the distal tibia
- Chapter 13
- Chapter 14
- Part IV Spine
- Part V Tendon injuries
- Part VI Compartments
- References
- Index
Summary
OPEN REDUCTION AND INTERNAL FIXATION: PLATING PILON
Indications
Fractures with > 2 mm articular incongruity.
Fractures with significant displacement of the metaphysis.
Reconstructable fractures (joint fragments that are large enough to hold small fragment screws).
Compartment syndrome.
Adequate soft tissue envelope.
Pre-operative planning
Clinical assessment
Mechanism of injury (fall from a height, skiing injury, motor vehicle accident, forward fall with a trapped foot).
Look for associated injuries.
Thoroughly assess the soft tissue condition.
Look for the presence of an open injury.
Assess the neurovascular status of the extremity.
Look for early signs or symptoms of compartment syndrome.
Review patient's past medical history and recognize the presence of existing medical conditions (diabetes, osteoporosis, vascular disease) that can modify the plan of treatment).
Displaced or dislocated fractures must be reduced immediately.
Radiological assessment
Standard high-quality anteroposterior (AP), lateral, 45° external rotation and mortise views of the ankle.
CT scan: provides information regarding the fracture pattern, the number and location of the cortical fragments, the extent of articular comminution and the amount of articular displacement (Fig. 12.35a,b,c).
Timing of surgery
Open fractures are treated on an emergency basis.
Generally it is determined by the condition of the soft tissues.
Simple fractures or fractures with minimal soft tissue injury can be definitively stabilized in 6–8 hours.
For other types of fractures a 6–12 day delay is preferable.
The use a joint bridging external fixator with elevation of the limb in the meantime is mandatory.
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- Information
- Practical Procedures in Orthopaedic Trauma Surgery , pp. 236 - 245Publisher: Cambridge University PressPrint publication year: 2006