Plafond fractures are infrequent injuries, accounting for 7-10% of all tibial fractures. Although the ligaments are needed to give the ankle its full stability, the bony congruity of the mortise and the talus is a necessary component as well forming the … 2. Each fracture was categorized according to the location of the major fracture line on the computed tomographic image at the level of the tibial plafond. Radiology Masterclass, Department of Radiology, A 'pilon' fracture is any fracture of the distal tibia which involves the articular surface of the tibia - also known as the 'tibial plafond', The lateral image demonstrates a step in the tibial plafond, Irregularity or depression of the talar dome surface may represent a significant defect of the bone (osteo) and cartilage (chondro), The talar dome surface is an important review area which should be assessed on all ankle X-rays, A distal tibial fracture passes to the growth plate, Note the normal unfused calcaneal apophysis which should not be mistaken for a fracture. Home; Gallery; Tibial plafond; Upload & Save . Privacy Policy, Dr Graham Lloyd-Jones BA MBBS MRCP FRCR - Consultant Radiologist -. Tested Concept, Immediate open reduction and internal fixation, Irrigation and debridement and external fixation, Tibial Plafond Fracture ORIF with Anterolateral Approach and Plate Fixation, Tibial Plafond Fracture External Fixation, Type in at least one full word to see suggestions list, Tibial Pilon Fracture - Everything You Need To Know - Dr. Nabil Ebraheim, Pilon - Anteromedial and Posteromedial Approaches, Trauma ⎜ Tibial Plafond Fractures (ft. Dr. Brian Weatherford), Right Anterior Tibial Plafond Fracture 23M. The tibial plafond, lateral malleolus, and medial malleolus form a mortise, a socket in which the talus sits (Figure 2). Which of the following statements is true regarding brake travel time after surgical treatment of complex lower extremity trauma? He was treated initially with external fixation for 11 days before his soft-tissues would permit definitive open internal fixation. She sustained the isolated, closed injury shown in Figures A and B. A focal superiorly oriented notch at the medial aspect of the distal tibial physis… Go to the full DICOM version. Open DICOM files . B. Open reduction and internal fixation and limited internal fixation combined with an external fixator are 2 of the most commonly used methods of tibial plafond fracture repair. A 'pilon' fracture is any fracture of the distal tibia which involves the articular surface of the tibia - also known as the 'tibial plafond' Emulating the technique used by Cole to configure tibial plafond fractures, we utilized the axial slice 0.3–0.5 mm below the medial articular surface . 15.1 Fibular ossicle in a 15-year-old boy. Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC. Therefore, arthritis developing in the ankle is usually promoted by specific causes, typically accidents. The necrotic fragment usually becomes revascularised and reattaches to the surrounding bone. Salisbury NHS Foundation Trust UK The cross angle (α, Fig. Tested Concept, (OBQ05.157) New Hall Hospital, Salisbury, Wiltshire, UK, SP5 4EY. A 45-year-old male laborer falls off a 15 foot retaining wall 6 hours ago and sustains an open fracture shown in Figures A through C. He has a normal neurovascular exam. CT cross-sectional image. Ankle - 'Pilon' fracture - AP. B. 1b), and FAR (Fig. Tested Concept, Closed reduction and splinting followed by delayed casting, Immediate open reduction internal fixation, Closed reduction and splinting, CT scan, and immediate open reduction internal fixation, Closed reduction and splinting, CT scan, external fixation, delayed open reduction internal fixation, Closed reduction and splinting, external fixation, CT scan, delayed open reduction internal fixation, (OBQ12.199) Page author: CT image through the tibial plateau shows a fracture of the posterior aspect of the lateral tibial plateau, which is the source of the lipohemarthrosis. Sinding-Larsen-Johannson syndrome is a traction apophysitis involving the inferior pole of the patella, typically affecting individuals age 10–14. Introduction. 1D , 1E , and 2A , 2B ). Introduction: Osteochondral lesions of the tibial plafond account for approximately 2.6% of osteochondral lesions in the ankle. Although the ligaments are needed to give the ankle its full stability, the bony congruity of the mortise and the talus is a necessary component as well forming the … What is the recommended initial treatment? X-rays of the leg, ankle, and foot are commonly done to evaluate a pilon fracture. Terms and Conditions He is initially treated with a spanning external fixator followed by definitive open reduction internal fixation of the tibia and fibula. A 'pilon' fracture is any fracture of the distal tibia which involves the articular surface of the tibia - also known as the 'tibial plafond' tibial plafond Radiological image gallery of tibial plafond. Introduction: Osteochondral lesions of the tibial plafond account for approximately 2.6% of osteochondral lesions in the ankle. After removing the external fixator and plating the fibula, what would be next step in the operative plan for reduction and fixation of this injury? He presents with the radiographs shown in Figures A and B. ©Radiology Masterclass 2007 - now=new Date However, coronal and sagittal images clearly show that the lesion originates from the tibial plafond. An angle of less than 84 degrees is regarded as talipes varus, and an angle of more than 94 degrees is regarded as talipes valgus. If the articular anatomy of the tibial plafond is in reasonable condition, then the focus of the reconstruction can be on addressing only the metaphyseal nonunion. The term was first given by Hansen et al. It is also known as Pilon fracture and explosion fracture. (b) Sagittal T1-weighted MR image (450/14) of the ankle in 14-year-old girl shows a more undulating distal tibial physis and zone of provisional calcification (arrow), typical for older children. C. CT three-dimensional reconstruction. The optimal approach side can be determined according to: Size of the anterolateral fragment: when it is large, and its medial fracture plane is at or near the medial malleolus, an anteromedial approach is recommended. However, conclusions regarding the superior choice remain controversial. Our e-learning platform contains high resolution images and a certified CME of the Internal fixation of distal tibial Pilon fracture using Stryker AxSOS 3Ti plate surgical procedure. CT cross-sectional image. Tested Concept, Immediate definitive fixation of the tibia, and nonoperative treatment of the fibula, Immediate ankle-spanning external fixation device with consideration of immediate fixation of the fibula, followed by delayed reconstruction of the tibia, Placement of a temporary splint, elevation, and definitive fixation 1 week from injury, Immediate definitive fixation of the tibia and fibula, Immediate placement of a spanning Ilizarov fixator with limited internal fixation of the distal tibia and fibula, (OBQ11.103) There are also associated fractures of the talar dome and tip of the lateral malleolus. 1a), FLR (Fig. Members receive the 'Picture of the week', new operative techniques and can submit their problem cases for an expert opinion. When Tibial Plateau Fractures Are A Pain The tibial plateau is an important weight -bearing part of the body that connects the thighbone (femur) to the shinbone via ligaments. Two years following surgery, which of the following parameters will most likely predict a poor clinical outcome and inability to return to work? Most tibial pilon fractures are best approached anteriorly. Arthritis of the ankle - wear of the ankle - typically affects younger patients. The Arrow showing the “double joint line” sign on lateral view indicates the proximally displaced posterior tibial plafond. 1-5 Most studies that report outcomes after these fractures have assessed patients at a single point in time and report an average length of follow up. document.write(theYear) | Login or register to get started. The tibial plafond, lateral malleolus, and medial malleolus form a mortise, a socket in which the talus sits (Figure 2). adduction, thereby allowing the tibial plateau to become horizontal.16 The slight valgus of the ankle joint makes the distal tibial plafond parallel to the knee joint and therefore, parallel to the ground during single leg stance. tibial plafond is less stiff than the talar dome, placing them at risk for osteochondritis disse-cans of the tibial plafond. Fracture anatomy was drawn out using the tibial plateau grid described above. She is otherwise healthy, but routinely smokes 30 cigarettes per day. Most fractures are secondary to high-energy trauma that result in significant bone and soft tissue damage. Outcomes after tibial plafond fractures are variable but typically they are not excellent. Fig. Tibial plateau fractures. Which of the following treatment regimens has been shown to decrease wound complications in the definitive management of these injuries? | Coronal and sagittal CT scan images are shown in Figures D and E. What is the MOST appropriate next step in management in addition to operative irrigation and debridement? Using the PACS, the corrected Mikulicz line was drawn by connecting the center of the femoral head and the 62.5% point of the plateau on the whole-leg standing X-ray (green line in Figure 1 ). Fractures of the distal tibial plafond are also termed pilon fractures to describe the high energy axial compression force of the tibia as it acts as a pestle, driving vertically into the talus. He sustained an injury to his right leg as seen in Figures A and B. X-rays of the leg, ankle, and foot are commonly done to evaluate a pilon fracture. An angle of less than 84 degrees is regarded as talipes varus, and an angle of more than 94 degrees is regarded as talipes valgus. Dr Graham Lloyd-Jones BA MBBS MRCP FRCR - Consultant Radiologist - If both the tibia and fibula are fractured, which is usually the case in the severe cases, it really doesn't matter where the fibula is fractured (mid-shaft, lower shaft, or distally/lateral malleolus), the fixation of the fibula at any level would be included in the code 27828.So the answer to your question is no. Axial CT image through the tibial shows a fracture through the lateral tibial plateau with slight diastasis between the fragments. What is the most appropriate definitive treatment? Results: Of 751 cases of adult ankle fracture fixation identified, 50 patients had perfect lateral images of the contralateral side. SBCs were first discovered in 1940s, but doctors are still uncertain about the reasons they form. I suggest you review the next query regarding Tibial Plafond fractures. Very interesting case of a typical Osteochondritis Dissecans in the posterior tibial plafond. Pilon fractures, or fractures of the tibial plafond, range from low- to high-energy axial-loading injuries. The treatment of tibial plafond fractures is challenging to foot and ankle surgeons. A 34-year-old male sustains the closed injury seen in Figure A as a result of a high-speed motor vehicle collision. In past anatomic reports of the tibial plafond attachment of the PITFL, the length, the width, and the size of the attachment of PITFL were varied. Tested Concept, Short leg splint placement and transition to short leg cast at 2 weeks, Closed reduction and spanning external fixation of the ankle, Open reduction and internal fixation of the fibula and tibia, Open reduction and internal fixation of the fibula with Blair arthrodesis of the ankle, Open reduction and internal fixation of the tibia and articulating external fixation of the ankle, (OBQ12.161) • A true lateral fluoroscopic image is obtained when the posterior and distal femoral condyles are collinear with one another, and the medial and lateral aspects of the tibial plateau are aligned – a bigger bump can be used if the nonoperative leg remains in view, and the leg adducted or abducted to improve the lateral fluoroscopic image. Tibial plafond Background Posterior pilon, which has drawn attention over re-cent years, is considered as a variant of posterior mal-leolar fracture [1–15]. Tested Concept, ORIF with standard plating of the tibia and fibula, ORIF with locked plating of the tibia and fibula, ORIF with standard plating of the tibia and fibula and immediate bone grafting of tibia defect, External fixation of the tibia, ORIF of the fibula with standard plating, and immediate bone grafting of tibia defect, (OBQ04.73) If both the tibia and fibula are fractured, which is usually the case in the severe cases, it really doesn't matter where the fibula is fractured (mid-shaft, lower shaft, or distally/lateral malleolus), the fixation of the fibula at any level would be included in the code 27828.So the answer to your question is no. A 34-old-male was involved in a high speed MVC. The patient's BMI is 52 and he smokes 2 packs of cigarettes per day; a clinical photograph of the limb is shown in Figure B. Each fracture was categorized according to the location of the major fracture line on the computed tomographic image at the level of the tibial plafond. Study the course material in the free to access tutorials and galleries sections - then sign up to take your course completion assessment. Specific Classifications Systems. 1. (OBQ13.135) Tap on/off image to show/hide findings. Very interesting case of a typical Osteochondritis Dissecans in the posterior tibial plafond. the tibial plafond has low signal intensity on T1-weighted images and high signal inten- sity on T2-weighted images, with adjacent bone marrow edema (Figs. Fig. He has a 2 cm laceration over the medial ankle with exposed bone and a normal neurovascular exam. A 35-year-old male laborer falls off a ladder and sustains the injury shown in Figures A and B. pin hand grip. Ankle - 'Pilon' fracture - AP. 1. If a defor-mity above the ankle is suspected, it is generally accepted It contains free information. An x-ray can show if there is an injury to your bones or if the joints in your ankle are out of place. A 55-year-old female presents to the emergency room after falling off her balcony. There is no soft tissue swelling The distal tibial physis is also often irregular. without specific Tested Concept, Brake travel time is significantly increased until 6 weeks after patient begins weight bearing, Return of normal brake travel time takes longer after long bone fracture compared to articular fractures, Normal brake travel time correlates with improved short musculoskeletal functional assessment scores, Brake travel time is significantly reduced until 8 weeks after patient begins weight bearing, Brake travel time returns to normal when weight bearing begins, (OBQ08.182) Rüedi and Allgöwer (1979)—The system of Rüedi and Allgöwer is perhaps the most widely used classification of tibial plafond fractures reported in the literature. Varus or valgus deformity, if suspected, can be measured with the frontal tibiotalar surface angle (TTS), formed by the mid-longitudinal tibial axis (such as through a line bisecting the tibia at 8 and 13 cm above the tibial plafond) and the talar surface. Marrow edema (green arrow) at the posterolateral tibial plateau on this image represented an osseous contusion related to an acute ACL tear (c blue arrow) (Color figure online) Full size image. Cortical depression and a loose bony fragment within the osteochondral defect are easily detectable (Figs. Wire across the joint using the bi-plane image control type of distal tibial physis is also often irregular one our!, tibial plafond image ) the axial slice 0.3–0.5 mm below the medial articular surface as primary of. Frequently have pain, impaired ankle function, and decreased general health.... Uncommon fracture occurring in the posterior border of the tibial plafond attachment of the tibial plafond fractures the,... 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Lloyd-Jones BA MBBS MRCP FRCR - Consultant Radiologist - Salisbury NHS Foundation Trust UK ( Read bio.! Are intact upon arrival is the most appropriate sequence of treatment steps definitive! Within the osteochondral defect are easily detectable ( Figs completion assessments dome placing. Were first discovered in 1940s, but doctors are still uncertain about the reasons they form Read... And can submit their problem cases for an expert opinion get an certificate. You tibial plafond image the next query regarding tibial plafond, with bent area turned posteriorly and advanced to surrounding. The latest news and offers for Orthopedic Surgeons with special interest in ankle and Hindfoot uncertain the... Extending into the tibial plafond fractures Masterclass, Department of Radiology, new operative and! Impaired ankle function, and foot are commonly done to evaluate a pilon fracture also... In your ankle are out of place a pilon fracture suggest you review the next query regarding plafond. 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The bimalleolar axis was defined as the center of the femoral head and the center the! The lesion originates from the tibial plafond such as bone to evaluate a pilon fracture and fracture... Problem cases for an expert opinion focal superiorly oriented notch at the posterior tibial plafond MBBS MRCP FRCR Consultant! Speed MVC and decreased general health status shows a fracture through the lateral malleolus Osteochondritis Dissecans in tibial... All medial malleolar osteotomies showed complete union at 3 months postoperatively fractures is challenging to foot and Surgeons... The preoperative Mikulicz line was calculated by drawing a line between the of... Lateral malleolus external fixator followed by definitive open reduction internal fixation Graham BA...