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

Case description 39-year-old man Fell into a deep pit (3 m) Trapped for 1 hour Neurovascular status intact C3.2, 2° open fracture

Discussion points How would you treat this fracture? How would you treat the soft tissue and bone? Which timing and sequence? Which surgical technique?

First step Debridement ORIF of the fibula Joint transfixation Vacuum assisted closure

Discussion What would you do now?

Second step Joint reconstruction, pilon plate Dorsalis pedis flap, mesh grafting of donor site Additional external fixation left for 1 week post reconstruction for control of soft tissues Discuss: how long to leave the external fixateur

4-year follow-up

4-year follow-up

Take-home messages Apply general principles for open fracture treatment Timing of surgery is important—staged approach for reconstruction Soft-tissue reconstruction allows for good bony reconstruction