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- Talk
- UK
Pilon Fractures Treated with Acute Tibiotalar Fusion - A New Approach to a Significant Injury
Description
This presentation led by Alistair Robertson focuses on the management of complex pilon fractures with tibiootalar fusion utilizing an antegrade tibial nail. Pilon fractures are described as severe injuries that present significant surgical challenges due to their high-energy nature and potential for soft tissue damage, leading to historically high complication rates. Robertson outlines a retrospective study conducted at a major trauma center over seven years, which reviewed pilon fractures and assessed a subset of patients who underwent tibiootalar fusion, measuring fusion rates, infection rates, and wound complications.
The innovative surgical approach employs an Ex-fix retained technique with tibial pin exchanges, utilizing arthroscopy for joint preparation and precise guidewire placement. Following the sequential reaming and insertion of a tibial nail with secured locking bolts, the protocol allows for immediate weight-bearing post-operatively.
A detailed case is discussed highlighting a high-energy fracture, showcasing intraoperative methods, and demonstrating results, including a 100% fusion rate with no complications. In contrast to traditional open reduction internal fixation procedures, which exhibited a higher complication profile, these findings suggest that tibiootalar fusion offers advantages such as an effective entry point, low complication rates, and the potential for faster recovery, making it a crucial option for managing complex pilon fractures.