Tibial Plafond Fracture External Fixation

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TECHNIQUE STEPS
Preoperative Patient Care
Operative Techniques
E

Preoperative Plan

1

Template fracture

  • template fracture pattern and instrumentation

2

Execute surgical walkthrough

  • describe steps of the procedure verbally to the attending prior to the start of the case
  • describe potential complications and steps to avoid them
F

Room Preparation

1

Surgical instrumentation

  • external fixation system

2

Patient positioning

  • patient supine with feet at the end of the bed, small bump under ipsilateral thigh, tourniquet on thigh
  • if external fixator in place need to scrub down frame and pins thoroughly as this is a source of contamination

3

OR setup and C-arm

  • radiolucent OR table
  • c-arm from contralateral side perpendicular to bed
G

Tibial Pin Placement

1

Mark and make the incision at the site of tibial pin insertion

2

Bluntly dissect down to bone

3

Place the tibial pins

  • place 2 Schanz pins into the midshaft of the tibia
  • avoid placing the pins in comprosied soft tissue and any fracture extension

4

Confirm the location with fluoroscopy

H

Calcaneal Pin Placement

1

Mark and make a skin incision at the site of the calcaneus pin insertion

2

Perform blunt dissection down to bone

3

Place the calcaneal pin

  • place a centrally threaded transfixation pin through the calcaneal tuberosity from medial to lateral
  • placing the pin in this direction helps avoid the posterior tibial artery
  • the location for this pin is 1.5 cm anterior to the posterior aspect of the heel and 1.5 cm proximal to the plantar aspect of the heel

4

Confirm the location with fluoroscopy

I

Bar Placement

1

Connect the tibial pins

  • place a solitary bar to connect the tibial pins

2

Place bars on the calcaneal pins

  • connect medial and lateral bars to each side of the heel
  • this makes a triangular configuration
J

Reduction

1

Reduce the fracture

  • perform longitudinal traction to obtain length
  • be sure to obtain the appropriate anteroposterior reduction
K

Metatarsal Pin Placement

1

Place the metatarsal pin

  • place a pin into the base of the first or second metatarsal
  • this maintains a plantigrade foot along with alignment

2

Connect the metatarsal pin to the mainframe

  • connect this forefoot pin to the main frame with connecting bar
  • hold the foot in neutral dorsiflexion
L

Reduction Confirmation

1

Take final fluoro AP/Lat/Mortise of ankle and AP/Lat of tibia/fibula

2

Check limb length, rotation, and alignment

Postoperative Patient Care
 

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