$fracture frame$

$fracture frame$

Open wounds are observed for extent of injury and degree of contamination. If the patient has a postoperative loss of sensory, motor, or vascular function, comparison with the preoperative evaluation is critical.

$fracture frame$

It is essential to have an accurate neurologic and vascular exam before surgery. A detailed neurologic exam with specific testing of deep and superficial peroneal, medial, lateral and calcaneal plantar nerves, saphenous, and sural nerve function is recorded. The lower leg and foot are evaluated for compartment syndromes, which do occur but are seen less commonly than in patients with high-energy tibial shaft fractures. If there is compromise to the circulation of the leg, consultation with vascular surgery is indicated. If undetectable or asymmetric with the opposite side, a Doppler examination is performed. The dorsalis pedis and posterior tibial pulse are palpated. In patients with skeletal deformity, gentle traction to grossly realign the limb should be performed and the extremity supported. The soft-tissue envelope of the distal one half of the tibia should be carefully evaluated for abrasions, blisters, or open wounds. On physical exam, the entire limb from hip to toes should be exposed, inspected, and examined for signs of injury. For surgeons who treat complex pilon fractures not amendable to plating, the technical drawings provided in this chapter may serve as a guide to address fractures with severe comminution, bone loss, and complex soft-tissue injuries. A bridging frame with limited internal fixation is a technique that surgeons with limited experience with circular ring frames can learn to apply. This chapter provides a comprehensive technique guide for application of circular fixation of pilon fractures ranging from fixation of extra-articular distal tibial fractures to complex articular injuries with bone loss. Increasing levels of soft-tissue damage, comminution of the distal tibia, and bone loss create a zone of injury, which makes external fixation an attractive treatment alternative. Despite the advent of locked plating and “minimally invasive” surgical techniques, internal fixation of high-energy pilon fractures is still associated with substantial risk. Furthermore, the extensive metallic surfaces inherent with internal fixation may increase the risk of bacterial colonization and subsequent infection. The chief advantage with this method of treatment is that it avoids the soft-tissue dissection in the zone of injury required to place plates. Circular external fixation with tensioned wires aligns and stabilizes these difficult and high-risk fractures with minimal additional soft-tissue injury and few major complications. Circular tensioned wire fixation of periarticular fractures of the distal tibia is a well-established method of treatment to manage selected pilon fractures as an alternative to internal fixation.

$fracture frame$

Fracture frame