Fracture Line Morphology and a Novel Classification of Pilon Fractures.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: The authors declare no conflicts of interest. 18. Oper Orthop Traumatol. 2018 Dec;30(6):435-456. doi: 10.1007/s00064-018-0570-8. Epub 2018 Oct 17. [Pilon fractures-considerations for treatment strategies and surgical approaches]. [Article in German] Stillhard PF(1), Frima H(2), Sommer C(2). Author information: (1)Klinik für Unfallchirurgie, Departement Chirurgie, Kantonsspital Graubünden, Chur, Schweiz. philipp.stillhard@ksgr.ch. (2)Klinik für Unfallchirurgie, Departement Chirurgie, Kantonsspital Graubünden, Chur, Schweiz. The majority of pilon or tibial plafond fractures are complex articular fractures and the treatment strategy, including the choice of the ideal surgical approach, is essential for a good functional outcome. In this paper, we discuss the considerations for dealing with such fractures as well as the pro and cons of the different approaches. The standard protocol consists of a two-staged procedure following the slogan span-scan-plan. After applying an ankle-spanning external fixator (span), the diagnostic work-up is completed by a CT scan with axial views, two-dimensional and three-dimensional reconstruction (scan) to fully understand the fracture pattern. Using this information, in coordination with the soft tissue situation, the ideal approaches, type and position of implants are planned in detail. This article, supported by clinical cases, describes different surgical approaches and the areas of interest which can be seen through these approaches as well as the implant position. DOI: 10.1007/s00064-018-0570-8