Polytrauma Ca Case P Presentation w with a Foc ocus on on Tibia - - PowerPoint PPT Presentation

Polytrauma Ca Case P Presentation w with a Foc

• cus on
• n Tibia Pi

a Pilon

• n F

Fractures es a and Soft Tissue M Managem emen ent

By: Jessyka Desrosiers 7/26/2019

Table of Contents

Introduction Case Overview Pilon Fractures Closing Remarks

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Introduction

• Name

me: Jessyka Desrosiers

• Home

metown: Port-Au-Prince, Haiti

• Undergraduate: Biomedical Engineering, Florida

International University

• Medical S

School

• ol: MS2, Morehouse School of

Medicine

• Curr

rrent I Inter eres ests: Joints and Trauma

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CASE OVERVIEW

32 y.o female ejected in MVA

• Dislocation of R glenohumeral joint
• Multiple tibial fractures
• sacroiliac joint and obturator ring fractures
• R rib fracture w/ pneumothorax
• Hepatic lobe laceration

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CASE OVERVIEW

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PILON FRACTURES

Backgr ground und

• Mechanis

ism o

• f i

f inju jury ry: A : Axia ial l l load (h (hig igh e energy) o

• r

rot

• tational (

(low energy) a and m major soft ft t tissue damage

• Fr

Frequ equency : : <1 <10% o

• f lower l

er limb inj njuri ries; es; incr creasi asing w with th surviv ival r l rate i in M MVA; R ; Related C Condit itio ions : : 75% a associa iated with f fibula fractures

• Poo
• or clinical ou
• utcom
• mes  mal

ales, es, c co-morb rbidities, es, lower er levels of incom

• me etc…)

…) Anatomy

Poste terolate teral (Volkmann) Anterola lateral ( (Chaput) Medial M Malleolar Frag agments

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PILON FRACTURES

Ima maging ng

• Xray
• CT
• 3D Reconstruction

Cla lassif ificatio ion

• Tscern

erne  Grades O1-O4 and C0-C3

• AO/OTA  43-A,B and C
• Ru

Ruedi and Allgowe wer  Type I, II and III

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PILON FRACTURES

Treatment/M /Management Surgical Opt ption n

• 1. Fibular length restoration
• 2. Reduction of the articular surface of the distal

tibia

• 3. Filling of metaphyseal bone defects with

cancellous autograph

• 4. Stabilization of the distal tibia

No Non-Sur urgical O Opt ption n

• 1. Long leg cast  6 weeks
• 2. ROM exercises

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PILON FRACTURES

Treatment/M /Management Fixation Joint Spanning External Fixation

• Can be used as definitive treatment
• Removed at 10th -21st day mark followed by

ORIF and/or IM Nail

• Ilizarov  C2 or C3 fractures

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PILON FRACTURES

Trea eatmen ent/Management Fixa xation Ilizarov variants

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PILON FRACTURES

Fibular Le Length R Restoration

• Reduction can be more accurate
• Important for syndesmotic injury
• When ?
• Lowers the rate of malunion when fixed with

plating

• No restoration improvement of metaphsyseal

contact for the tibia

“To

To fix ix or

• r not

not to to fix ix: : th that is is th the e ques uestion” n”

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PILON FRACTURES

Com Complications

• Wound breakdown
• Non-union
• Posttraumatic arthritis
• Chondrolysis
• Malunion
• Stiffness
• Pin site infections

Outcomes

• Lower SF-36 scores compared to pelvic fracture,

HIV and coronary disease at 2 year follow up

• Full recovery  <38%

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PILON FRACTURES

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My Experience !

Zy Zyrconium !!! !!!

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Thank you !

Dian ane P Payne, MD Edward Jackson I III, M MD Scott Bo Boden, MD Yolanda Wimberly, M MD Thom

• mas M

Moor

• re,

e, Jr., M MD Res esiden ents: G Gregor

• ry Ku

Kurkis, R

• R. Matthew

ew Wh Wham IV, M Matthew ew Lunati, , Matthew Br Broggi, M Ming Phen en, J Jac acob W Wilson an and Andrew S Schwartz J.L. Reed, A Anna Br a Bridges an and Sonya S Seymour

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References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6220009/ https://www.orthobullets.com/trauma/1046/tibial-plafond- fractures https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4666229/#CR10 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5213932/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5579433/pdf/PA MJ-27-199.pdf https://www.sciencedirect.com/science/article/pii/S09582592150 0070X https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4666229/

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