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

2. Case description 29-year-old man Motor vehicle accident
Massive swelling

4. Discussion points
Type of fracture?
Which approach(es)?

5. Step 1—temporizing external fixator

6. Step 2—surgical approach and definitive internal fixation
Anterior midline incision for articular reconstruction
The plate can be slid up subcutaneously for proximal fixation

7. Intraoperative x-rays
Metaphyseal reduction—turning type C into type B
Reconstruction of the plafond from posterior to anterior

10. 2-month follow-up

11. Take-home messages Staged fixation for severe soft-tissue trauma
Plan approaches according to 3-D fracture anatomy
Direct vision of the plafond with comminution
Femoral distractor for vision of the joint surface
Turn fracture type C into type B to ease reduction