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 39-year-old man Fell into a deep pit (3 m)
Trapped for 1 hour
Neurovascular status intact
C3.2, 2° open fracture

3. Discussion points How would you treat this fracture?
How would you treat the soft tissue and bone?
Which timing and sequence?
Which surgical technique?

4. First step Debridement ORIF of the fibula Joint transfixation
Vacuum assisted closure

5. Discussion
What would you do now?

6. Second step Joint reconstruction, pilon plate
Dorsalis pedis flap, mesh grafting of donor site
Additional external fixation left for 1 week post reconstruction for control of soft tissues
Discuss: how long to leave the external fixateur

7. 4-year follow-up

8. 4-year follow-up

9. Take-home messages
Apply general principles for open fracture treatment
Timing of surgery is important—staged approach for reconstruction
Soft-tissue reconstruction allows for good bony reconstruction