Name: External Fixation of Pilon Fracture Using the ArthroFX™ System
Uploaded: 2018-03-19T00:00:00Z
Channel: Arthrex

Foot and Ankle

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VPT1-00998-EN | B | External Fixation of Pilon Fracture Using the ArthroFX™ System

John T. Riehl

Human

Surgeons presenting one or more clinical cases

Chirurg:innen präsentieren einen oder mehrere klinische Fälle

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Cirurgiões que apresentam um ou mais casos clínicos.

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Cirujanos que presentan uno o más casos clínicos.

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External Fixation of Pilon Fracture Using the ArthroFX™ System

First case is a 44 year old female involved in a head on motor vehicle collision. She had ankle pain and deformity, which was reduced and splinted by the emergency department. This was a closed injury. She's neurovascular intact. No significant past medical history. Nonsmoker works in a retail store. These are her preoperative X-rays showing comminuted distal tibia fracture with an associated fibula fracture. She was taken directly from the emergency department to the operating room, with a plan for a temporary external fixation in order to restore length and alignment and stability to this ankle. Also, temporary external fixation was placed to allow soft tissue swelling to subside and to and allow Definitiv internal fixation in a delayed fashion. These are intraoperative X-rays show. In this case, I placed two pins in the tibia pre-drill for those tibial pins. I place a calcaneal pin that's centrally threaded, and then I'll place a fourth pin in the medial cuneiform in order to control ankle dorsiflexion. Plantar flexion. I tend to use JumpStart dressings around the pin sites, and I'll place pressure dressings there as well. So once her ankle has been pulled out to length, then length, then I can get a postoperative CT scan that shows me all the fragments and allows for better preoperative planning. This is her postoperative CT scan before her Definitiv surgery, so she was admitted overnight following the external fixator discharged home. Postoperative day one made non-weight bearing and returned to the operating room at two weeks for an anterior approach to the pilon fracture, with an anterolateral Arthrex plate being placed using TRIM-IT pins as well to fix intermediate segments of bone and a long FibuLock nail. Her wounds healed uneventfully, so my indications for external fixator in general damage control, orthopedic situations, whether that be local damage control or in a multi trauma case where I'm trying to avoid a second hit to the organ systems for local soft tissue management. Deformity correction. Intraoperative distraction is another very useful tool for external fixation and for infection management. Second case I'd like to share with you. It's a 40 year old female. She was assaulted, had pain in her left knee with an inability to bear weight. Admitted to the hospital with a closed tibial plateau fracture by one of my partners, who then referred her to me the next day. These are her injury. X-rays, AP and lateral views of the left knee. And her X-rays show this big condylar tibial plateau fracture. This is a closed injury. She had symmetric Doppler pulses. No compartment syndrome. And she had shortening and medial displacement, as you can see on this AP view. With that medial displacement I have a little bit heightened concern about vascular status. And so I like to take out the Doppler and listen to pulses and listen for symmetry from side to side. So Intraoperatively I placed two pins in the femur, two pins in the tibia, and I pre-drill those tibial pins. The pin clusters were secured, and then I placed bars and clamps, and I tightened the proximal clamps, pull the limb out to length, and then I'll tighten those distal clamps to hold my reduction. These are her postoperative x rays, showing the external fixator in place and restoration of length and alignment, and then sent her for a postoperative CT for Definitiv operative planning. She was kept overnight. Pulse was monitored and had no compartment syndrome. So post operative day one, she was discharged to home. She returned to the operating room ten days after her injury for external fixator removal and Definitiv open reduction. Internal fixation through a dual approach. I placed a posterior medial buttress plate followed by a lateral buttress plate, and did a sub meniscal arthrotomy in her case. And with these widely displaced tibial plateau fractures, I find lateral meniscus tears from time to time and debrided that through that open sub meniscal arthrotomy. Her wounds healed uneventfully. I just want to highlight some of the versatility of this external fixation system. I've used it in multiple body regions for multiple indications. I use it in damage control situations where I have to externally fixate multiple bones throughout both limbs. It's great for a delta frame application. I've used it on knee spanning external fixators for distal femur fractures, tibial plateau fractures, and for knee dislocations. It's usable in the pelvis with long, 250 millimeter pins that can be used to place an anterior frame. And I've even used it in the upper extremity and as supplemental fixation to additional internal fixation, as well as use as intraoperative distraction.

External Fixation of Pilon Fracture Using the ArthroFX™ System

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