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Tibial Plafond Fractures
Posted: Sep 24 2021 #(C101793)
A

Pilon Fracture in 64M

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HPI

A 64-year-old male presents to the trauma bay after sustaining a fall from a ladder. The patient reports he was approximately 10 feet high when he lost his balance. He reports isolated left ankle pain and denies hitting his head or losing consciousness. He denies numbness/tingling in the left foot.

PMH

PMH: HTN, HLD

PE

Focused exam of the left lower extremity demonstrates moderate swelling to the left ankle without open wounds or blisters. The skin does wrinkle. Motor grossly intact EHL/FHL/GSC. Sensation intact to all distributions of the foot. PT/DP pulses are palpable and foot is warm and well perfused.

Poll
1 of 12
Would you obtain any imaging in addition to standard ankle films to guide management?
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P: 137688
Would you use a classification system to guide management?
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P: 137697
How would you definitively manage this injury?
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P: 137689
If you choose Operative management, would you temporize this patient with an external fixator?
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P: 137690
If you choose Operative management, what definitive fixation technique would you use?
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P: 137691
If you choose Operative management, would you include fixation of the fibula?
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P: 137693
If you choose to Fix the fibula, what type of fixation would you use?
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P: 137694
If you choose ORIF and made the patient non weight bearing after surgery, what DVT prophylaxis would you prescribe?
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P: 137721
If you choose ORIF with plate and screws of the tibia AND fibula, when would you fix the fibula?
Other
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P: 137695
If you choose Operative Management and attained the construct shown below, when would you allow the patient to begin weight-bearing postoperatively?
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P: 137696
If you choose ORIF, which posterior based approach(es) would you utilize to treat the tibia?
Other
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P: 137698
If you choose ORIF, which anterior based approach(es) would you utilize to treat the tibia?
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P: 137699
PROCEDURE #1

ORIF L pilon fracture (CPT 27827). APPROACH: The patient was initially positioned prone. A posterolateral approach was carried out and posterior buttress plate applied followed by posterior fibula fixation. The patient was then positioned supine. An anteromedial approach was carried out. The anterior plafond was reduced and fixed provisionally followed by fixation to the posterior segment and plating.

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