Abstract
Introduction: Tibial pilon fractures are complex and difficult to manage. Results with extensile approaches, rigid internal fixation and bone grafting remain poor. Percutaneous treatment does not allow anatomic restoration. Current classifications are not helpful. Understanding the anatomy and behaviour of the fracture would allow development of logical algorithms for treatment.
Method: We have analysed plain radiographs and CT scans in a consecutive series of 126 pilon fractures and have defined the fracture anatomy and developed a new classification.
Results: There are six constant articular fragments: anterior, anterolateral (insertion of AITFL), medial, posterior, posterolateral (insertion of PITFL) and die-punch.
Two main fracture families exist depending on the articular fracture pattern. T-type and V/Y-type fractures. A lateral disruption type fracture represents a further important group. An evolution of fracture is evident within the groups.
T-type fractures tend to occur in varus and result from higher energy injuries in younger patients. V/Y-type fractures tend to occur in valgus and result from lower energy injuries in older patients.
Conclusions: We have defined distinct articular fragments, allowing development of safe direct surgical exposures. Stabilisation of the tibial fracture with fine-wire fixators or plates may be employed. The Pathoanatomy could be used in optimal design of such plates. Defining the fracture types gives us a useful and reproducible classification of injury.
These abstracts were prepared by Editorial Secretary, George Sikorski. Correspondence should be addressed to Australian Orthopaedic Association, Ground Floor, The William Bland Centre, 229 Macquarie Street, Sydney, NSW 2000, Australia.
At least one of the authors is receiving or has received material benefits or support from a commercial source.
