Characteristics and proposed classification system of posterior pilon fractures

Zhang, Jianzheng; Wang, Hao; Pen, Cheng; Qu, Wen chun; Duan, Lida; Ren, Jixin; Li, Lianhua; Li, Zhi; Sun, Tiansheng

doi:10.1097/md.0000000000014133

Cited by 11 publications

(5 citation statements)

References 19 publications

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“…The average AOFAS score was 86.6 points in Group A, which was similar with some previous studies ( 1 , 4 , 10 ). Moreover, Group B had more satisfactory clinical outcomes than Group A in terms of AOFAS and ankle ROM, suggesting the advantages of the lateral approach via stretching fibular fracture line in postoperative functional recovery.…”

Section: Discussionsupporting

confidence: 91%

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Treatment outcomes of posterior pilon fractures using a simple single lateral approach via stretching fibular fracture line

et al. 2023

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PurposeThe aim of this study was to explore the treatment outcomes of a novel single lateral approach via fibular fracture line for patients with posterior pilon fractures.Patients and methodsFrom January 2020 to December 2021, a total of 41 patients with posterior pilon fractures who received surgical treatment in our hospital were retrospectively reviewed. Twenty patients (Group A) were treated with open reduction and internal fixation (ORIF) via posterolateral approach. Twenty-one patients (Group B) were treated with ORIF using a simple single lateral approach via stretching fibular fracture line. Clinical assessments, including operation time, intraoperative blood loss, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, visual analogue scale (VAS), and the active range of motion (ROM) of the ankle at the final follow-up visit after surgery, were performed in all patients. Radiographic outcome was evaluated by using the criteria proposed by Burwell and Charnley.ResultsThe mean follow-up time was 21 months (range 12–35). The average operation time and intraoperative blood loss in the Group B were significantly less than those in the Group A. Moreover, the AOFAS score and ankle ROM in the Group B were significantly higher than those in the Group A at the final follow-up visit. Eighteen cases (90%) in Group A and 19 cases (90.5%) in Group B achieved anatomical reduction of the fracture.ConclusionThe single lateral approach via stretching fibular fracture line is a simple and effective technique for reduction and fixation of posterior pilon fractures.

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Section: Discussionsupporting

confidence: 91%

“…Recently, posterior pilon fractures has gained increasing interest in clinical practice due to its poor outcome ( 2 , 3 ). Anatomically, posterior pilon fractures extends to the medial malleolus ( 4 , 5 ). Posterior pilon fractures are caused by rotation and axial load and characterized with large fracture fragments ( 6 ).…”

Section: Introductionmentioning

confidence: 99%

Treatment outcomes of posterior pilon fractures using a simple single lateral approach via stretching fibular fracture line

et al. 2023

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“…Recently, several authors inferred the fracture mechanism from CT-depicted fracture morphology, [ 24 , 27 , 39 , 46 , 56 ] and a large posterior malleolar facture with medial extension is often referred to as a posterior pilon fracture [ 16 , 22 , 40 – 42 ] because, as mentioned above, it seems to be the result of axial loading forces exerted when the talus is forced into the distal tibia. Mechanisms proposed for this fracture pattern differ: from an abduction external rotation force combined with high axial loading, [ 57 ] to forced hyperplantarflexion, [ 45 , 56 ] to rotational and axial loading combined. [ 5 ] Vosoughi et al [ 46 ] classified the medial fragment of the fracture involving the entire posterior tibial margin with 2 fragments into 2 categories: small avulsion-type fracture and large pilon-type fracture.…”

Section: Discussionmentioning

confidence: 99%

Mechanism of posterior malleolar fracture of the ankle

Haraguchi

Armiger

2020

OTA International: The Open Access Journal of Orthopaedic Trauma

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Objectives: Ankle fracture treatment involves reduction of the bone fragments and stabilization of the joint by reversing the mechanics of injury. For posterior malleolar fracture however, the true mechanism is not understood, leading to a lack of consistent guidance on how to best treat this injury. Methods: Fifteen cadaver ankles were subjected to fracture loading that replicated the Lauge-Hansen pronation-external rotation mechanism. An axial load was applied to each specimen, which was mounted on a materials testing machine, and the foot was rotated externally to failure. Digital video cameras recorded the failure sequence of specific anatomic structures. Results: Posterior malleolar fracture occurred in 7 specimens. Of these, 1 was an intra-articular fracture, another was a fracture involving the entire posterior tibial margin consisting of 2 fragments: that of the posterior tubercle and that of the posteromedial margin of the tibial plafond, with the former judged to be a consequence of avulsion by the posterior inferior tibiofibular ligament and the latter a consequence of axial loading from the talus. In the remaining 5 specimens, the posterior malleolar fracture was a small extra-articular avulsion fracture. Conclusions: Fractures at the posterolateral corner of the distal tibia were shown to be avulsion fractures attributed to the posterior inferior tibiofibular ligament and produced by external rotation of the talus. A fracture involving the entire posterior tibial margin consisting of 2 fragments can be produced by a combination of avulsion by the posterior inferior tibiofibular ligament and axial loading from the talus.

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“…In fact, they have been divided into: posterior malleolus by rotation and posterior pylon due to high impact vertical trauma. There is even an excellent classification in three types [20] . In our case, the posterior malleolus fracture was not accompanied by a lower syndesmal diastasis, a fact reported by some authors [21] .…”

Section: Discussionmentioning

confidence: 99%

Tibial pylon fracture associated with talus fracture and infrasindesmal spiral fibula. Case report and literature review

Nieto¹

2020

Int. J. Orthop. Sci.

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Combined fractures of the tibial pilon and the adjacent bones are infrequent. We present a case of a 59year-old female with a complex foot and ankle trauma resulting in an unusual combined ipsilateral fracture of the tibial pilon, talus neck, fibula spiral and dislocation. The fractures were treated by open reduction with anatomic reconstruction. To the best of our knowledge, this combination of fractures has not yet been reported in the literature.

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Characteristics and proposed classification system of posterior pilon fractures

Cited by 11 publications

References 19 publications

Treatment outcomes of posterior pilon fractures using a simple single lateral approach via stretching fibular fracture line

Treatment outcomes of posterior pilon fractures using a simple single lateral approach via stretching fibular fracture line

Mechanism of posterior malleolar fracture of the ankle

Tibial pylon fracture associated with talus fracture and infrasindesmal spiral fibula. Case report and literature review

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