Case for small group discussion Pilon fracture Case for small group discussion C2 pilon fracture treated with the MIPO technique AOTrauma—Foot & Ankle Module 1b: Ankle trauma—pilon fractures Matthew Tomlinson

Case description Day 0 19-year-old man Chased by police, jumped 4 m Isolated, closed injury Hemodynamics OK No neurovascular problems Compartments OK Hip/knee OK Initial joint-bridging external fixation

Fracture classification Day 0

Fracture classification Day 0 4 3 C 3

Discussion What are the goals of treatment? Day 0 Anatomical joint reconstruction / reduction Correct length, alignment, & rotation of metaphysis Normal ankle and limb function

Discussion Day 0 What are the goals of treatment? Anatomical joint reconstruction/reduction Correct length, alignment, and rotation of the metaphysis Normal ankle and limb function

What are the treatment options? Day 12 Soft tissues are OK

Preoperative planning is essential

Goal 1—anatomical joint reduction/ reconstruction Day 12 Open approach Direct reduction Lag screw fixation

Goal 2—length, alignment, rotation of metaphysis Indirect reduction Percutaneous technique Bridge plate Standard and locking screws

Immediate postoperative rehabilitation protocols? Discuss all options of rehabilitation including weight bearing protocols

18-month follow-up Anatomical joint reconstruction Correct length, alignment, and rotation of the metaphysis Normal ankle and limb function

Take-home messages Realize the need for absolute and relative stability at different areas of the fracture Think about the soft tissues Have a preoperative plan Understand indications for locked plating and intramedullary nailing Evaluate risks and benefits of minimally invasive plate osteosynthesis