Name: Pilon Fracture Repair Using the Arthrex Variable Angle SS Distal Tibial Plating System
Uploaded: 2026-01-28T00:00:00Z
Channel: Arthrex
Description: Kyle Schweser, MD (Columbia, MO), demonstrates an anterior approach, dissection, and steps for using the Arthrex Variable Angle SS Distal Tibial Plating System, showcasing the benefits of variable-angle locking screws.

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Kyle Schweser, MD (Columbia, MO), demonstrates an anterior approach, dissection, and steps for using the Arthrex Variable Angle SS Distal Tibial Plating System, showcasing the benefits of variable-angle locking screws.

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VID1-008677-en-US | A | Ankle Fracture Repair Using the Arthrex Variable-Angle SS Distal Tibia Plating System

Kyle Schweser, MD

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Pilon Fracture Repair Using the Arthrex Variable Angle SS Distal Tibial Plating System

Today we're going to be discussing application of an anterolateral distal tibial plate for pilon fractures through an anterior medial approach. And we're going to be highlighting the benefits of variable angle locking screws through the system. So there's a few ways that you can do an anteromedial approach to the distal tibia. The traditional way is to be about a centimeter lateral to the crest of the tibia. And you come down and then curve at the joint line following anterior Tib down, there's a modified way where you can come down along the crest and you actually curve along the medial malleolus, and then across the foot. That's used more for total ankle approaches. Or you can even take it down and curve a little bit more along the medial malleolus if you need to get really far. Medial kind of helps you with your with your visualization. That way we'll kind of stick with the traditional approach today, which will mark about a centimeter off the crest here. Okay. We have our malleoli tips of our malleoli here. So our joint line is going to be about right here. And our anterior tib is right here. And so we'll start coming down. And then at the level of the joint we'll kind of curve and go along anterior Tib there. It's really important when you're doing approaches for the pilon that you try and limit the amount of cuts that you make through the fat. And so you want to limit feathering if possible. You want to limit getting into your anterior tib tendon sheath or any of the other tendon sheaths. We're going to curve along here. And kind of once you get down to your layer it's a little bit easier. So we've got our fat here. We're going to get down and we're going to try and show you our fascial layer without getting into. Okay. So there's our there's our fascial layer. You can see some muscle belly over here. This is going to be anterior anterior tibialis tendon. So I'm going to grip the fat layer deep here not the skin. And we can kind of keep raising this up until we get to the medial side of anterior tibialis. So here's anterior tibialis. We're still within its sheath here. Okay. You can palpate the crest of the tibia here. There's a couple ways that you can make sure you're outside of the tendon sheath. Some people will kind of push the tendon out of the way. They'll push it laterally. And you can kind of see it moving within its sheath. I actually prefer to push it medially because it shows kind of the extent of where the tendon sheath actually is, this little bulging over here. So I know that if I make my cut kind of medial to that bulge, then I'm going to be outside of the tendon sheath. And so then I'll just come straight down on the bone kind of following that tendon sheath. And then usually I'll grab here, create a little window on our bone. And you can just stay on bone and come right under all your important structures. Lift it up. We can change out this key for the Hohmann. And you can see that when you do that, you can see that you've got these connections down here to the bone like your periosteum and your fascia. And we'll just elevate this up off the bone and take we're going to take all these structures over laterally. Now in a pilon I would normally try and find. So one, you're going to have some bleeders down here in the fat pad. We're not worrying about that right now, but you'd want to find some of those bleeders in the fat pad. And then I would find one of the main fracture lines that would come through. And that's where I would go through the capsule. And so here it would be, you know, we can imagine it would be here. And I would kind of go through the capsule to get our exposure, and then we would lift kind of the joint, the joint piece out of the way with our capsule taking it over. But you can see here there's our talar dome right there, our tibial plafond right there. Right. To make it easier for exposure here, we'll just go ahead and lift all the capsule up. But I would try and preserve this if we were actually fixing a pilon. And I would do that by using the fracture lines. You can see with an anteromedial approach. You can see here's there's the anterolateral or Chaput, the central plafond. And then over here medially. If we need to raise if we need to put medial medial plates on or get a reduction, you can continue to kind of lift this periosteum up. And just for exposure standpoint, I'll go ahead and really release all this. But you can put a medial plate through this approach and kind of buttress this area up as well. But you can see how much of the distal tibia you can get with this approach here. So again there's the the talus. There's our tibiotalar joint and our plafond right there. So we have an AP image here which shows our plate. It's in a good position. It's covering our entire anterior distal tibia. You can see you can kind of make out the Chaput fragment or the lateral part of the distal tibia and see that the plate is covering there and then extending over medially. Here's our lateral x ray which shows plate placement. It's sitting on the distal tibia really well. We have a k-wire in place to help hold the position. Our anterolateral plate is now applied. Normally at this point you would have your joint fixed or at least provisionally fixed with no lag screws k-wires provisional plates and we'll put the plate on. I usually like to get the plate down to bone with a non-locking screw proximally. We have one up here just to just to keep the plate steady and to and to help it contour down to the bone. When you're ready to start fixing it distally, we can use this aiming guide, which gives you about 15 degrees or a 30 degree cone. You can see it sits well in, in the screw hole. And then as we start to move it, it pops out whenever we've lost that kind of 15 degrees. And we're going to really highlight kind of the spread of screws that we can get with this system. This is a calibrated drill bit to let's do a 36. So we'll take the screws down, tighten it. You can see that screw really locks in even with that 15 degrees. Okay, here's an AP image showing our final construct. With all of our screws in place, you can just make out that anterolateral distal tibia, what you would call the Chaput fragment and see how the plate is capturing that really well. Here's our lateral x ray showing. The plate sits nicely on the distal tibia, and you can see a good spread of the screws and kind of the trajectory that you can get with the variable ankle guide. Here's our final construct of the plate. You can see that it has good bony contact. The plate itself is low profile as are the screws. So there's no prominent screw heads here. It spans the distal tibia well. And then when we take out our retractors you can see that our fascia is still intact overlying our anterior tibialis tendon. It lays nicely over the end of the plate.

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Pilon Fracture Repair Using the Arthrex Variable Angle SS Distal Tibial Plating System

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