Name: Pilon Fracture With Anterolateral and Posterior Distal Tibia Fracture Plating System
Uploaded: 2016-09-21T00:00:00Z
Channel: Arthrex
Description: Jesse Doty, MD (Chattanooga, TN), demonstrates an open reduction internal fixation (ORIF) of a pilon fracture using the Distal Tibia Fracture Plating System.

<p>Jesse Doty, MD (Chattanooga, TN), demonstrates an open reduction internal fixation (ORIF) of a pilon fracture using the Distal Tibia Fracture Plating System.</p>

Not Hidden

English  - en

video

VID1-00825-EN | C | Pilon Fracture with Anterolateral and Posterior Distal Tibia Fracture Plating System

Jesse Doty

Human

A video recording of a surgical technique on a live patient in an operating room setting or a cadaveric demonstration.

Eine Videoaufnahme einer Operationsanleitung an einem lebenden Patienten oder Patientin in einem Operationssaal oder eine Demonstration an einem Humanpräparat.

Operationstechnikvideos

Surgical Technique Videos

Gravação em vídeo de uma técnica cirúrgica em um paciente em uma sala de cirurgia ou uma demonstração cadavérica.

Vídeos de técnicas cirúrgicas

Grabación en vídeo de una técnica quirúrgica de un paciente en un quirófano o una demostración cadavérica.

Videos de técnicas quirúrgicas

Pilon Fracture With Anterolateral and Posterior Distal Tibia Fracture Plating System

Today I'm going to highlight the Arthrex Pilon open reduction internal fixation system. This is a bad pilon fracture which was open at the time of injury. Medially it was temporized in a spanning external fixator. Upon evaluation of the CT scan, there are three primary fragments with intercalary comminution down near the articular surface. In my hands this requires a posterior as well as anterior approach. The posterior approach is safely performed between the fibula and the Achilles tendon. The nerve may cross the field distally or release the FHL off the inner aspect of the fibula. The peroneal tendons can then be retracted either medially or laterally to allow access to the fibula fracture. Oftentimes I'll start with my fibula reduction first, which can be anatomically reduced and keyed into position. Once it's keyed into position, I can hold that with a K-wires or lag screws. The FibuLock reduction helps to push the posterior Mo down into an optimal position to get a reduction of the posterior articular surface. Once I've got the posterior Mo down and pinned in position, I'll attempt to maintain my fibula length with the fibula plate. These plates are both left and right specific. They're anatomically contoured, and they can be bent, and they're certainly malleable enough to contour to the posterior aspect of the fibula. There's a posterior plate as well as a posterior lateral plate in addition to the standard fibula plates. These plates encompass 2.7mm locking screws distally and 3.5mm non locking screws proximally. These can be drilled and put into position with a ratchet, screwdriver, or as well as the power driver attachment. I can oftentimes measure with a depth gauge. Or sometimes I prefer to utilize the drill bit. And then can be measured off of the locking drill guides, which we'll show shortly. In this case, this is the Arthrex depth gauge, which point I can confirm the length of a 3.5mm non-locking screw in the lateral aspect and the proximal segment of the fibula. I generally try not to fill in the entire plate at this time, because I don't want to preclude a good view of the posterior aspect of the tibia. Again, we want to obtain an anatomic reduction of the posterior Volkmann fragment or posterior molar fragment. I'll place just enough screws to give me adequate stability of the fibula, and to maintain my length until I can get a good reduction of the posterior aspect of the tibial plafond. The insertion of the most proximal non-locking screw. And now you can see on these lateral images I feel like we've maintained our FibuLock length with the plate, and then we've pinned that posture mile down into position into intact metaphysis proximally. Once I've confirmed the positioning of the posterior aspect of the plafond, I'll apply the posterior tibial plates. These plates are also anatomically contoured, with a multitude of screw options and a multitude of length options to best treat each fracture. Here I'm drilling with a 2.5, followed by insertion of a 3.5mm cortical screw. Depending on what I'm attempting to accomplish with the plate, I'll regulate whether I insert the non-locking screws in the shaft approximately first, to act as a buttress to compress down the apex of the plate, versus sometimes, when I already feel like I've pinned in an anatomic position, I'll place the 2.7mm locking screws first. In this case, the plate fits nicely, and then I have a multitude of options to place my 2.7mm millimeter locking screws. It's of particular importance to remember I have to go to the front of the ankle as well. And for that reason, if I use too long of screws, that will preclude a reduction anteriorly, which can be very frustrating. And so in this case I'll use lateral imaging to confirm length of my screws to make sure I haven't violated into those most coronal fracture lines. And so again measuring off the laser etched marks locking screws more distally. And this is a 3.5mm locking screw. Once I've evaluated my imaging I can see that I still have plenty of room to obtain that anterior reduction. I've buttressed down the posterior wall fragment, and I feel like my fibula is out to length at this point. I'll drill and fill again using the laser etch marks on the drill guide to insert 2.7mm screws distally. And to make sure I have adequate fixation to maintain my fibula length. At this point, I'm confident of my reduction of the posterior aspect of the tibia, and so I can go ahead and fill in whichever screw options I think are the most optimal for stability. And I'm least concerned with my visibility of the posterior aspect of the tibia. I'll then close this, at which point I'll prep and drape. I begin the anterior approach through skin subcutaneous tissue and preserve the extensor retinaculum. The tendons can be mobilized medially or laterally to optimize visualization. I pull the anterior fragment down and into position, which can be pinned, and then can be confirmed with positioning on the x ray. At this point, I feel like the anterior coronal fragment fracture line has been reduced and the major should put fragment is down and into position. I'll then insert lag screws using a depth gauge followed by a 2.7mm non-locking screw. In this case there's a rim plate which can which can be very beneficial to act as a washer to capture the screw heads onto the anterior soft bone of the tibia. Another 2.7mm lag screw. To hold that coronal fragment, I inserted these screws, as well as 3.5mm non-locking screws to capture the medial mal fragment seen here on x ray. Once I feel like I have the articular surface reduced, this is the plate inserter, which then slides the plate into position, followed by insertion of a drill guide, and then the drill guide can be pinned to the intact metaphysis and proximally to help with positioning of the plate, which I confirm on x ray. In this case, I chose to insert 2.7mm locking screws first, as I felt like I already had adequate reduction. I just wanted to maintain buttress of that anterior comminution. So with insertion of these screws, again it's important to check the depth. In this case I can go ahead and drill through the posterior aspect of the plafond as I know that the posterior fragments are now reduced. So here, insertion of 3.5 nonlawyers proximally. Again, the drill is etched to help with measuring the depth of the screws. It's important to remember that these screws are low profile, and they sink nicely into the plate, which is contoured to accept the screw head and decrease some of the prominence and soft tissue irritation on the anterior aspect of the plate. Here I'm using a depth gauge. Again, I may aim more proximally to help decrease the stress riser at the proximal aspect of the plate. These plates are left and right specific with different lengths. You can see on the x ray. Here I feel like I have good fixation, adequate buttress posteriorly and anteriorly.

Pilon Fracture With Anterolateral and Posterior Distal Tibia Fracture Plating System

Related Pages

Trauma Lower Extremities

Distal Tibia Plating System

Product

Trauma Lower Extremities

Internal Fixation for Distal Tibia Fracture/Pilon

Procedure