1. 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

2. 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

3. Fracture classification
Day 0

4. Fracture classification
Day 0 4 3 C 3

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

6. 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

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

8. Preoperative planning is essential

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

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

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

12. 18-month follow-up Anatomical joint reconstruction
Correct length, alignment, and rotation of the metaphysis
Normal ankle and limb function

13. 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