14th March - pilon and malleolar fractures
Venue - Burnley General Hospital
As trainees were struggling to get to Burnley for 2pm last week the start time for this session will be 2:15. Please try to get here on time as we have a lot of material to cover.
Leader - Mr JL Barrie
Topic - pilon and malleolar fractures
Pilon fractures
Perhaps the best example of the AO aphorism that a fracture is a soft tissue injury with a broken bone in the middle! I’m aiming to cover:
- What is a pilon fracture?
- Fracture patterns, classification and the role of CT
- Soft tissue management
- Modern treatment options
- joint reconstruction
- external fixation
- minimal access plating
- complications and their management
Suggested reading
Topliss CJ et al. Anatomy of pilon fractures of the distal tibia. J Bone Joint Surg Br. 2005 May;87(5):692-7
Papadokostakis G et al. External fixation devices in the treatment of fractures of the tibial plafond. JBJS 2008 Jan;90(1):1-6
Bacon S et al. A retrospective analysis of comminuted intra-articular fractures of the tibial plafond: open reduction and internal fixation versus external Ilizarov fixation. Injury 2008; 39:196-202
Gillian Jackson’s presentation on external fixation
Akeel Bhutta’s presentation on plating was modified from the presentation in the OTA teaching collection (well worth a visit - they’re free to use provided you acknowledge the source)
Malleolar fractures
The usual management of ankle fractures is based on a combination of tradition and misunderstandings of “classic” papers. I hope to challenge almost all you know about ankle fractures - but you might not want to do it in your own unit!
- Biomechanics of malleolar fractures
- Classifications - are they any use?
- Undisplaced ankle fractures - functional management or plaster?
- Displaced ankle fractures - MUA or ORIF?
- Technical issues
- syndesmotic injuries
- medial and posterior malleolar fractures
- post-op care
- Ankle fractures in the elderly and diabetics, and other impossible problems
Suggested reading
Bauer M et al. Malleolar fractures: nonoperative versus operative treatment. CORR 1985; 199:17-27
Michelson JD et al. Motion of the ankle in a simulated supination- external rotation fracture model. JBJS, 1996. 78A(7):1024-1031
Port AM, McVie JL, Naylor G & Kreibach DN. Comparison of two conservative methods of treating an isolated fracture of the lateral malleolus. JBJS, 1996. 78B(4):568-572
Dattani RL et al. Injuries to the tibiofibular syndesmosis (review article). JBJS 2008; 90B:405-10
and many more!
Given the difference between the evidence-based and traditional management of malleolar fractures I hope there will be some discussion of evidence-based practice in orthopaedics in the blog.
Please note - I’ve noticed some broken links in the Hyperbook trauma sections. If you have a problem go back to the homepage - the links there have been repaired