Case for small group discussion Pilon fracture Case for small group discussion AOTrauma—Foot & Ankle Module 1b: Ankle trauma—pilon fractures Hans Zwipp and Stefan Rammelt, DE

Case description 47-year-old man, road traffic accident Poor skin condition, chronic venous insufficiency There is no way to perform regular surgery due to condition of soft tissues.

Discussion points What are the management options? Are there alternatives to ORIF?

Percutaneous athroscopically assisted reduction Internal fixation with screws and non ankle-spanning hybrid external fixation

Postoperative x-rays

1.5-year follow-up Fixator removed at 10 weeks No complaints at last follow-up Not even the K-wires bothered him

Take-home messages Consider alternatives to ORIF when soft-tissue conditions are bad Ensure anatomical joint reduction with MIPO techniques (arthroscopy, 3-D fluoroscopy) Ensure stable fixation Consider ankle sparing fixation to allow early rehabilitation Reference: Rammelt S, Endres T, Grass R, et al. The role of external fixation in acute ankle trauma. Foot Ankle Clin. 2004 Sep;9(3):455–474, vii–viii. Rammelt et al. Foot Ankle Clin. 2004;9:455–474, vii–viii