Date: Fri, 30 Aug 2002 17:09:21 -0400
Subject: Pilon fx + segmental defect
30 year old male, 10 weeks out from open fracture of distal tibia. Large anterolateral flap which looks healthy and just needs some STSG. Now shows up in my clinic. Slightly decreased sensation in dorsal foot, plantar normal. Decreased toe extension presumably from loss of anterior compartment and muscle damage.
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How would you treat?
Date: Fri, 30 Aug 2002 16:47:17 -0500
From: Anglen, Jeffrey
My vote is acute shortening, tibio-talar fusion, re-lengthening through a proximal corticotomy (bifocal compression-distraction).
Jeff
Jeffrey O. Anglen MD FACS
Chief, Orthopaedic Trauma Service
Columbia, MO
Date: Sat, 31 Aug 2002 13:06:32 +0530
From: Dr Mangal Parihar
My tuppence worth....
Acute shortening to till you get bone contact between the proximal and
distal fragments.
Minimal internal fixation oriented tranversely, subchondral, to secure
the medial malleolus
Fill in the remaining area with cancellous bone graft
Lengthen thru a proximal corticotomy
Sacrificing the distal fragment entirely, and aiming for a tibio talar fusion is another option....
Mangal parihar
Orthopedic surgeon, mumbai
Date: Mon, 2 Sep 2002 12:07:27 -0400
From: James Carr
I favor shortening, and trying to preserve the ankle segment with some internal fixation- plate vs crossed screws. Bone graft well. Ankle motion is sometimes suprising because of the shortening. Let this heal, then lengthen above using your method of choice. I prefer monorail technique.
Jim Carr
James B. Carr, MD
Palmetto Health Orthopedics