Top

BMC Musculoskeletal Disorders

Published in:

Open Access 01-12-2016 | Technical advance

Modified posteromedial approach for treatment of posterior pilon variant fracture

Authors: Yukai Wang, Jianwei Wang, Cong feng Luo

Published in: BMC Musculoskeletal Disorders | Issue 1/2016

Abstract

Background

Posterior pilon variant fracture is a recently described posterior malleolus fracture characterized by the involvement of both posterolateral and posteromedial malleolar fragment. The associated surgical approach remains controversial. The aim of this study was to present the application of modified posteromedial approach in the treatment for posterior pilon variant fracture.

Methods

Sixteen patients were identified with posterior pilon variant fractures. All fractures were operated via modified posteromedial approach. Fragment length ratio, area ratio and height were measured as morphologic assessments. The clinical outcome was evaluated with American Orthopaedic Foot & Ankle Society ankle-hind foot score and visual analogue scale. Radiological images were evaluated using osteoarthritis-score.

Results

According to the radiological measurements, the average fragment length ratio of posteromedial and posterolateral fragment was 25.3 and 31.5 % respectively. All fractures healed within a mean period of 13.1 weeks without malalignment or articular step-off. Fourteen patients were followed up, and all achieved good or excellent ankle function. The average score of American Orthopaedic Foot & Ankle Society and visual analogue scale at rest, motion and weight bearing walking was 85.6 and 0.25, 0.81, 1.31 respectively.

Conclusion

Modified posteromedial approach provides an alternative surgical treatment for posterior pilon variant fractures, and the short-term outcome was good.

Available only for authorised users

Hansen S. Functional reconstruction of the foot and ankle. Philadelphia: Lippincott Williams & Wilkins; 2000.

Weber M. Trimalleolar fractures with impaction of the posteromedial tibial plafond: implications for talar stability. Foot Ankle Int. 2004;25(10):716–27.PubMed

Mangnus L, Meijer DT, Stufkens SA, Mellema JJ, Steller EP, Kerkhoffs GM, et al. Posterior malleolar fracture patterns. J Orthop Trauma. 2015;29(9):428–35. doi:10.1097/BOT.0000000000000330.CrossRefPubMed

Haraguchi N, Haruyama H, Toga H, Kato F. Pathoanatomy of posterior malleolar fractures of the ankle. J Bone Joint Surg Am. 2006;88(5):1085–92. doi:10.2106/JBJS.E.00856.CrossRefPubMed

Amorosa LF, Brown GD, Greisberg J. A surgical approach to posterior pilon fractures. J Orthop Trauma. 2010;24(3):188–93. doi:10.1097/BOT.0b013e3181b91927.CrossRefPubMed

Tornetta 3rd P, Ricci W, Nork S, Collinge C, Steen B. The posterolateral approach to the tibia for displaced posterior malleolar injuries. J Orthop Trauma. 2011;25(2):123–6. doi:10.1097/BOT.0b013e3181e47d29.CrossRefPubMed

Kao KF, Huang PJ, Chen YW, Cheng YM, Lin SY, Ko SH. Postero-medio-anterior approach of the ankle for the pilon fracture. Injury. 2000;31(2):71–4.CrossRefPubMed

Karachalios T, Roidis N, Karoutis D, Bargiotas K, Karachalios GG. Trimalleolar fracture with a double fragment of the posterior malleolus: a case report and modified operative approach to internal fixation. Foot Ankle Int. 2001;22(2):144–9.PubMed

Buchler L, Tannast M, Bonel HM, Weber M. Reliability of radiologic assessment of the fracture anatomy at the posterior tibial plafond in malleolar fractures. J Orthop Trauma. 2009;23(3):208–12. doi:10.1097/BOT.0b013e31819b0b23.CrossRefPubMed

10.

Abdelgawad AA, Kadous A, Kanlic E. Posterolateral approach for treatment of posterior malleolus fracture of the ankle. J Foot Ankle Surg. 2011;50(5):607–11. doi:10.1053/j.jfas.2011.04.022.CrossRefPubMed

11.

Franzone JM, Vosseller JT. Posterolateral approach for open reduction and internal fixation of a posterior malleolus fracture--hinging on an intact PITFL to disimpact the tibial plafond: a technical note. Foot Ankle Int. 2013;34(8):1177–81. doi:10.1177/1071100713481455.CrossRefPubMed

12.

Klammer G, Kadakia AR, Joos DA, Seybold JD, Espinosa N. Posterior pilon fractures: a retrospective case series and proposed classification system. Foot Ankle Int. 2013;34(2):189–99. doi:10.1177/1071100712469334.CrossRefPubMed

13.

Switaj PJ, Weatherford B, Fuchs D, Rosenthal B, Pang E, Kadakia AR. Evaluation of posterior malleolar fractures and the posterior pilon variant in operatively treated ankle fractures. Foot Ankle Int. 2014;35(9):886–95. doi:10.1177/1071100714537630.CrossRefPubMed

14.

Chen DW, Li B, Aubeeluck A, Yang YF, Zhou JQ, Yu GR. Open reduction and internal fixation of posterior pilon fractures with buttress plate. Acta Ortop Bras. 2014;22(1):48–53. doi:10.1590/S1413-78522014000100009.CrossRefPubMedPubMedCentral

15.

Wang L, Shi ZM, Zhang CQ, Zeng BF. Trimalleolar fracture with involvement of the entire posterior plafond. Foot Ankle Int. 2011;32(8):774–81.CrossRefPubMed

16.

Forberger J, Sabandal PV, Dietrich M, Gralla J, Lattmann T, Platz A. Posterolateral approach to the displaced posterior malleolus: functional outcome and local morbidity. Foot Ankle Int. 2009;30(4):309–14. doi:10.3113/FAI.2009.0309.CrossRefPubMed

17.

Drake ML, Farber GL, White KL, Parks BG, Segalman KA. Restoration of longitudinal forearm stability using a suture button construct. J Hand Surg [Am]. 2010;35(12):1981–5. doi:10.1016/j.jhsa.2010.09.009.CrossRef

18.

Yao L, Zhang W, Yang G, Zhu Y, Zhai Q, Luo C. Morphologic characteristics of the posterior malleolus fragment: a 3-D computer tomography based study. Arch Orthop Trauma Surg. 2014;134(3):389–94. doi:10.1007/s00402-013-1844-0.CrossRefPubMed

19.

Markolf KL, Schmalzried TP, Ferkel RD. Torsional strength of the ankle in vitro. The supination-external-rotation. Clin Orthop Relat Res. 1989;246:266–72.PubMed

20.

Crist BD, Khazzam M, Murtha YM, Della Rocca GJ. Pilon fractures: advances in surgical management. J Am Acad Orthop Surg. 2011;19(10):612–22.CrossRefPubMed

21.

Tarkin IS, Clare MP, Marcantonio A, Pape HC. An update on the management of high-energy pilon fractures. Injury. 2008;39(2):142–54. doi:10.1016/j.injury.2007.07.024.CrossRefPubMed

22.

Topliss CJ, Jackson M, Atkins RM. Anatomy of pilon fractures of the distal tibia. J Bone Joint Surg (Br). 2005;87(5):692–7. doi:10.1302/0301-620X.87B5.15982.CrossRef

23.

Young KW, Deland JT, Lee KT, Lee YK. Medial approaches to osteochondral lesion of the talus without medial malleolar osteotomy. Knee Surg Sports Traumatol Arthrosc. 2010;18(5):634–7. doi:10.1007/s00167-009-1019-2.CrossRefPubMed

24.

Eastman JG, Firoozabadi R, Benirschke SK, Barei DP, Dunbar RP. Entrapped posteromedial structures in pilon fractures. J Orthop Trauma. 2014;28(9):528–33. doi:10.1097/BOT.0000000000000046.CrossRefPubMed

25.

Assal M, Ray A, Fasel JH, Stern R. A modified posteromedial approach combined with extensile anterior for the treatment of complex tibial pilon fractures (AO/OTA 43-C). J Orthop Trauma. 2014;28(6):e138–45. doi:10.1097/01.bot.0000435628.79017.c5.CrossRefPubMed

26.

Lidder S, Masterson S, Dreu M, Clement H, Grechenig S. The risk of injury to the peroneal artery in the posterolateral approach to the distal tibia: a cadaver study. J Orthop Trauma. 2014;28(9):534–7. doi:10.1097/BOT.0000000000000089.CrossRefPubMed

27.

Attinger CE, Evans KK, Bulan E, Blume P, Cooper P. Angiosomes of the foot and ankle and clinical implications for limb salvage: reconstruction, incisions, and revascularization. Plast Reconstr Surg. 2006;117(7 Suppl):261S–93S. doi:10.1097/01.prs.0000222582.84385.54.CrossRefPubMed

28.

Edgcombe H, Carter K, Yarrow S. Anaesthesia in the prone position. Br J Anaesth. 2008;100(2):165–83. doi:10.1093/bja/aem380.CrossRefPubMed

Title: Modified posteromedial approach for treatment of posterior pilon variant fracture
Authors: Yukai Wang
Jianwei Wang
Cong feng Luo
Publication date: 01-12-2016
Publisher: BioMed Central
Published in: BMC Musculoskeletal Disorders / Issue 1/2016
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/s12891-016-1182-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Modified posteromedial approach for treatment of posterior pilon variant fracture

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2016

Combined unicompartmental knee arthroplasty and anterior cruciate ligament reconstruction in knees with osteoarthritis and deficient anterior cruciate ligament

A comparison of multidisciplinary team residential rehabilitation with conventional outpatient care for the treatment of non-arthritic intra-articular hip pain in UK Military personnel – a protocol for a randomised controlled trial

Few geographic and socioeconomic variations exist in primary total shoulder arthroplasty: a multi-level study of Australian registry data

Do psychological and behavioral factors classified by the West Haven-Yale Multidimensional Pain Inventory (Swedish version) predict the early clinical course of low back pain in patients receiving chiropractic care?

Coronal tibial slope is associated with accelerated knee osteoarthritis: data from the Osteoarthritis Initiative

The Wuerzburg procedure: the tensor fasciae latae perforator is a reliable anatomical landmark to clearly identify the Hueter interval when using the minimally-invasive direct anterior approach to the hip joint