The classification for distal femur fractures can be seen in Figure 34.1 and is defined as follows 8: 1996 May. On the basis of plain radiographic findings, the prevalence of liga… The sagittal and coronal reformations provide additional data, especially for identifying impacted segments that are rotated relative to the axial images. One successful strategy involves construction of a medial triangular external fixator that relies on an intact or plated fibula, against which tension can be applied. If open reduction is anticipated, reestablishment of the length of the tibia and fibula is necessary. There is a Tillaux fracture due to avulsion of the anterolateral part of the distal tibia by the anterior syndesmosis. Nonoperative treatment of distal tibial fractures is recommended only for truly nondisplaced fractures or fractures in patients that have an absolute contraindication for surgical management. After placement of the proximal 5-mm bicortical tibial pin (perpendicular to the anteromedial face of the tibia) and the 5-mm calcaneal tuberosity pin (parallel to the distal tibial coronal plane articular surface), length and coronal alignment can be obtained. Cheung Y, Perrich KD, Gui J et-al. The peroneal muscles (longus and brevis) occupy the lateral compartment of the leg, have a distal muscle belly posteriorly, and are firmly attached at the distal fibula by the peroneal sheath. Because of the complexity of these injuries, multiple surgical approaches are frequently required. 166(5):1203-6. 34.9) is useful in the majority of complete articular (type 43C) pilon fractures, anterior and anterolateral partial articular (type 43B) pilon fractures, and some extra-articular distal tibial fractures that can be stabilized with a plate slid beneath the anterior compartment (Fig. Video 34.1 ORIF Using a Periarticular Plate, Video 34.2 Locked Plating of a Pilon Fracture. Weight bearing and ankle range-of-motion exercises should be delayed until there is radiographic evidence of healing, frequently requiring at least 12 weeks. 4. The superficial peroneal nerve is purely sensory and travels from posterior to anterior, crossing the anterolateral surgical incision (Fig. {"url":"/signup-modal-props.json?lang=us\u0026email="}. After evaluating the patient, the fracture characteristics, and the integrity of the soft tissue envelope, operative fixation of a pilon fracture can proceed. Other closed methods such as calcaneal traction may allow serial soft tissue evaluations and provide some joint distraction and ligamentotaxis, but patient compliance and prolonged bed rest are required. In some highly comminuted fibular fracture patterns that are not amenable to direct reduction techniques, indirect reduction of the fibula is accomplished. However, the prerequisites of such an approach include the following: A complete understanding of the injury, the fracture pattern, and the associated articular involvement, Confidence that a thorough debridement of the open injury has been done in a timely manner, An understanding of the techniques through which the surgeon can reduce and internally fix portions of the injury with “minimally invasive” methods, A well-rested and appropriate surgical team. However, in cases of severe metaphyseal impact, metaphyseal bone loss, or osteopenia, there may be a role for these implants. Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), Proximal Humerus Fractures and Shoulder Dislocations. Physical examination of the injured lower extremity should include a careful assessment of the local swelling, perfusion, and neurologic deficits. It is caused by a pronation-external rotation mechanism. The fibula extends distally relative to the tibia, and is firmly attached by the anterior and posterior tibiofibular ligaments. Role of Magnetic Resonance Imaging in the Diagnosis of Distal Tibia Fractures in Adolescents. However, every effort should be made to retain all articular segments, irrespective of the soft tissue attachments. Case contributed by RMH Core Conditions Diagnosis certain Diagnosis certain . A simplified AO/OTA classification differentiates between two-part fractures (type A), wedge fractures with butterfly fragments of varying size and possible comminution (type B), and complex fracture, including segmental and multipart comminuted fractures without contact between the proximal and distal diaphyseal segments (type C). Tibial plateau fractures may occur together with meniscal and ligamentous injuries to the knee. (1979). Equipment Used for Open Reduction and Internal Fixation of Pilon Fractures, Medium femoral distractor (used to distract between the talus and midshaft of the tibia to enable visualization of the distal tibial articular surface), Kirschner wires (K-wires) of varying sizes, 2.5-mm terminally threaded pins as joysticks, Small-fragment screws (2.7 and 3.5 mm; with long lengths, e.g., 60 to 80 mm), Mini-fragment screws (2.0 and 2.4 mm; with long lengths, e.g., 40 mm), Headlight to visualize the articular surface, Multiple plates consistent with the screws and preoperatively planned bone tamps, Allograft bone chips (as necessary) versus a bone graft substitute. Ankle fractures are usually the result of indirect mechanisms, whereas the majority of pilon fractures are the result of an axial loading mechanism in which the talus is forced cranially and into the distal tibia, thus producing the “explosion” fracture of the articular surface. MSK radiology interpretation and presentation osce Fractures radiology. Triplane fracture of the distal tibia. All fractures were classified as SH type I–V or triplane fractures type I–III. The AO classification of distal clavicular fractures along with the Neer classification system is one of the more frequently used classification systems when assessing distal clavicular fractures. As the complexity increases, the number of fragments and the associated comminution increase. Computed tomography is essential for the evaluation of the injuries. Classification of femoral shaft fractures is straightforward. Radiology Department of the Rijnland Hospital, Leiderdorp, the ... you need to understand the classification of ankle fractures and exorotation injuries that were highlighted in Ankle - Fractures 1 and 2. posterior malleolus fracture. The anterior tibial compartment contains, from medial to lateral, the tibialis anterior, the extensor hallucis longus (EHL), the extensor digitorum communis (EDC), and the peroneus tertius. However, the reproducibility and usefulness of this classification system have been questioned. Consideration of tension versus compression failure has implications from a biomechanical standpoint when fixation is considered. Most commonly, associated open wounds are located medially. Frequently adopted is the one proposed by Ruedi and Allgower 5: type I: articular fracture with minimal or no displacement. Fibular fracture forefoot is still short mobilization can proceed based on the than... Becomes most relevant when considering displacement patterns and planes of safe surgical dissection motion of the tibia... 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