1. 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

2. 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.

3. Discussion points What are the management options?
Are there alternatives to ORIF?

4. Percutaneous athroscopically assisted reduction
Internal fixation with screws and non ankle-spanning hybrid external fixation

5. Postoperative x-rays

6. 1.5-year follow-up Fixator removed at 10 weeks
No complaints at last follow-up
Not even the K-wires bothered him

7. 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