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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
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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.
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Discussion points What are the management options?
Are there alternatives to ORIF?
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Percutaneous athroscopically assisted reduction
Internal fixation with screws and non ankle-spanning hybrid external fixation
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Postoperative x-rays
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1.5-year follow-up Fixator removed at 10 weeks
No complaints at last follow-up Not even the K-wires bothered him
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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 Sep;9(3):455–474, vii–viii. Rammelt et al. Foot Ankle Clin. 2004;9:455–474, vii–viii
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