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 ocus on on Tibia Pi a Pilon on 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

Introduction • Name me: Jessyka Desrosiers • Home metown: Port-Au-Prince, Haiti • Undergraduate: Biomedical Engineering, Florida International University • Medical S School ool: MS2, Morehouse School of Medicine • Curr rrent I Inter eres ests: Joints and Trauma    

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    

CASE OVERVIEW    

PILON FRACTURES Backgr ground und • Mechanis ism o of i f inju jury ry: A : Axia ial l l load (h (hig igh e energy) o or rot otational ( (low energy) a and m major soft ft t tissue damage • Fr Frequ equency : : <1 <10% o of 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 omes  mal oor clinical ou outcom ales, es, c co-morb rbidities, es, lower er levels of incom ome etc…) …) Anatomy Frag agments Anterola lateral ( (Chaput) Medial M Malleolar Poste terolate teral (Volkmann)    

PILON FRACTURES Ima maging ng • Xray • CT • 3D Reconstruction Cla lassif ificatio ion • erne  Grades O1-O4 and C0-C3 Tscern • AO/OTA  43-A,B and C • wer  Type I, II and III Ru Ruedi and Allgowe    

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    

PILON FRACTURES Treatment/M /Management Fixation Joint Spanning External Fixation • Can be used as definitive treatment Removed at 10 th -21 st day mark followed by • ORIF and/or IM Nail • Ilizarov  C2 or C3 fractures    

PILON FRACTURES ent/ Management Fixa Trea eatmen xation Ilizarov variants    

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 or not not to to fix ix: : th that is is th the e ques uestion” n”    

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%    

PILON FRACTURES    

My Experience ! Zy Zyrconium !!! !!!    

Thank you ! Dian ane P Payne, MD Edward Jackson I III, M MD Scott Bo Boden, MD Yolanda Wimberly, M MD Thom omas M Moor ore, e, Jr., M MD Res esiden ents: G Gregor ory 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    

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/    