In this article, we present how to treat ankle pilon fractures, especially staged external-internal fixation by a case discussion. We also review the current concepts of the pilon map to select a surgical approach by preoperative CT and AP/ML column buttressing.

1. Ankle Fracture
Pilon fracture : Pilon-Column concept
Chun-Hao Tsai,MD
中國醫藥大學 附設醫院
骨科部 副教授 蔡俊灝 醫師
Associate Professor
Department of Orthopedic Surgery, China Medical University Hospital,
Taichung, Taiwan, R.O.C.

2. •Gender: Male
•Age:20
•Presenting Symptoms: painful deformity of bilateral ankles
•Clinical History:: falling down form 4 floor height, suicided
•Comorbidities :psychosis , L2 burst fracture
•Other Consideration: nil

7. Fracture Pattern
• Axial Load
• Varus
• Valgus
• Sagittal Plane
• Anterior
• Posterior

8. Protocol
for ORIF One stage
•Time Interval
•Configuration of ExFix
•Fix the fibula?
•Plate or K-wire?
Staged

9. Pre-op Planning Pilon Map
{Cole, 2013 #42}

11. Articular Component
• Interfragmentary Compression
of Articular surface
• Lag using appropriately sized lag
screws either by technique or
design
• Place as close to articular
surface as possible

12. Definitive Fixation Strategy
• Rotation of posterolateral fragment
• Fix to posterolateral fragment
• Medial to posterolateral
• Central impaction
• Anterolateral fragment
• Secure articular segment
• Span joint to diaphysis

13. How many plate you need?
•Single
•Dual
•Triple

14. Column fixation concept
type C B / type CA
{Haller, 2019 #20}

15. AO43A3
• varus
• medial plates >> anterolateral
plates.
• anti-glide mode
• valgus
• no biomechanical differences
{Pirolo, 2015 #65}

16. Dual Plating Deficient in capturing the medial malleolar
fragment, a second plate is necessary
PERI-LOC LCP VA-LCPInjury, 2018-02-01

17. Surgical approach
Second incision
• Anteromedial
• Anterocentral
• Anterolateral
• Posteromedial
• Posteromedial
• Posterolateral

18. 12004466

19. 標題
/p 1 M
Anteromedial
Anterolater
Anterolateral

20. /p 6 M well union

21. Take home message –Pilon-Column concept
• Soft tissue vs Fracture pattern
• Axial CT, varus vs. Valgus
• Go buttress needed for direct reduction in direct visualization
• Double –Triple plate for Column fixation
• Second incision necessary? Proximal extension
• surgical approach based on axial CT scans{Zhao, 2020 #74}
• Posterolateral approach combined with an anteromedial or anterior
approach
• Posteromedial approach combined with an anterolateral or
• anterior approach
{Kottmeier, 2018 #62}