Journal of Foot and Ankle Surgery (Asia Pacific)

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VOLUME 11 , ISSUE 2 ( April-June, 2024 ) > List of Articles

CASE SERIES

Role of Intramedullary Fibular Fixation: Strategies for Addressing Complex Pilon Fractures

Kyle Auger, Ian S Hong, Jaclyn M Jankowski, Richard S Yoon

Keywords : Fibula, Fibular, Intramedullary fixation, Pilon, Technique

Citation Information : Auger K, Hong IS, Jankowski JM, Yoon RS. Role of Intramedullary Fibular Fixation: Strategies for Addressing Complex Pilon Fractures. J Foot Ankle Surg Asia-Pacific 2024; 11 (2):73-79.

DOI: 10.5005/jp-journals-10040-1331

License: CC BY-NC 4.0

Published Online: 02-04-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Aim and background: Pilon fractures are usually the result of a high-energy mechanism and are widely considered more of a soft tissue injury secondary to the high rates of soft tissue complications that arise from them. The majority of pilon fractures have an associated fibular fracture in which minimally invasive intramedullary fixation has been utilized to minimize soft tissue complications. In this manuscript, we present three different cases that highlight different intramedullary fixation techniques. Technique: Cut flexible guidewire, standard cortical screw, intramedullary fibular nail. Conclusion: Intramedullary fixation for associated fibular fractures in the setting of pilon fractures has been shown to be a viable technique for successful outcomes. There are a variety of options for intramedullary fixation that can be utilized, and guidewire, cortical screw, and intramedullary fibular nail techniques are demonstrated in our case examples with tips to help produce good outcomes. Clinical significance: Using minimally invasive intramedullary fibular fixation can help mitigate risk of wound complications in high-risk pilon fractures. Level of evidence: V (expert opinion).


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  1. Bhattacharyya T, Crichlow R, Gobezie R, et al. Complications associated with the posterolateral approach for pilon fractures. J Orthop Trauma 2006;20(2):104–107. DOI: 10.1097/01.bot.0000201084.48037.5d
  2. Sirkin M, Sanders R, DiPasquale T, et al. A staged protocol for soft tissue management in the treatment of complex pilon fractures. J Orthop Trauma 1999;13(2):78–84. DOI: 10.1097/00005131-199902000-00002
  3. O'Toole RV, Joshi M, Carlini AR, et al. Local antibiotic therapy to reduce infection after operative treatment of fractures at high risk of infection: a multicenter, randomized, controlled trial (VANCO study). J Orthop Trauma 2017;31(Suppl 1):S18–S24. DOI: 10.1097/BOT.0000000000000801
  4. Stannard JP, Robinson JT, Anderson ER, et al. Negative pressure wound therapy to treat hematomas and surgical incisions following high-energy trauma. J Trauma 2006;60(6):1301–1306. DOI: 10.1097/01.ta.0000195996.73186.2e
  5. Stannard JP, Volgas DA, McGwin G 3rd, et al. Incisional negative pressure wound therapy after high-risk lower extremity fractures. J Orthop Trauma 2012;26(1):37–42. DOI: 10.1097/BOT.0b013e318216b1e5
  6. Yeramosu T, Satpathy J, Perdue PW, et al. Risk factors for infection and subsequent adverse clinical results in the setting of operatively treated pilon fractures. J Orthop Trauma 2022;36(8):406–412. DOI: 10.1097/BOT.0000000000002339
  7. Luk PC, Charlton TP, Lee J, et al. Ipsilateral intact fibula as a predictor of tibial plafond fracture pattern and severity. Foot Ankle Int 2013;34(10):1421–1426. DOI: 10.1177/1071100713491561
  8. Blauth M, Bastian L, Krettek C, et al. Surgical options for the treatment of severe tibial pilon fractures: a study of three techniques. J Orthop Trauma 2001;15(3):153–160. DOI: 10.1097/00005131-200103000-00002
  9. Deivaraju C, Vlasak R, Sadasivan K. Staged treatment of pilon fractures. J Orthop 2015;12(Suppl 1):S1–S6. DOI: 10.1016/j.jor.2015.01.028
  10. Erichsen JL, Andersen PI, Viberg B, et al. A systematic review and meta-analysis of functional outcomes and complications following external fixation or open reduction internal fixation for distal intra-articular tibial fractures: an update. Eur J Orthop Surg Traumatol 2019;29(4):907–417. DOI: 10.1007/s00590-019-02368-9 PMID: 35937519.
  11. Poutoglidou F, Metaxiotis D, Vasiliadis AV, et al. Plate fixation versus percutaneous rush pinning for osteosynthesis of the fibula in pilon fractures. A retrospective comparative study. Hippokratia 2021;25(2):63–68. PMID: 35937519.
  12. Faber RM, Parry JA, Haidukewych GH, et al. Complications after fibula intramedullary nail fixation of pilon versus ankle fractures. J Clin Orthop Trauma 2021;16:75–79. DOI: 10.1016/j.jcot.2020.12.025
  13. Evans JM, Gardner MJ, Brennan ML, et al. Intramedullary fixation of fibular fractures associated with pilon fractures. J Orthop Trauma 2010;24(8):491–494. DOI: 10.1097/BOT.0b013e3181eb5c4f
  14. Huang CW, Wu WT, Yu TC, et al. Retrograde intramedullary kirschner wire fixation as an alternative for treating distal fibular shaft fractures combined with distal tibial pilon fractures. J Pers Med 2022;12(7):1124. DOI: 10.3390/jpm12071124
  15. Prissel MA, Daigre JL, Brandão RA, et al. Cross-sectional analysis of the distal fibular intramedullary canal: a cadaveric evaluation. Foot Ankle Spec 2018;1938640017751190. DOI: 10.1177/1938640017751190
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