Pilon Fracture ORIF / Ex Fix 27828

Distal tibia Pilon fracture xray

Pilon fracture lateral view xray

Pilon fracture external fixation xray

Pilon fracture CT scan

CPT Coding Technique
Indications Complications
Contraindications Follow-up Care / Rehab Protocol
Alternatives Outcomes
Pre-op Planning / Case Card Review References

synonyms: external fixation, pilon fracture ORIF, ORIF tiiial plafond

Pilon Fracture ORIF CPT

Pilon Fracture ORIF Indications

Pilon Fracture ORIF Contraindications

Pilon Fracture ORIF Alternatives

Pilon Fracture ORIF Pre-op Planning

  • Ensure appropriate plates, screws and external fixation is available. 

Pilon Fracture ORIF Technique

  • Sign operative site.
  • Pre-operative antibiotics, +/- regional block.
  • General endotracheal anesthesia
  • position. All bony prominences well padded.
  • Examination under anesthesia.
  • Prep and drape in standard sterile fashion.
  • Irrigate.
  • Close in layers.

Pilon Fracture Temporay External Fixation Technique

  • Transmetatarsal pinning from medial to lateral should be avoided due to risk of dorsalis pedis artery injury (Barrett MO, JBJS 2008;90A:560)
  • Place two 5mm half-pins into anterior tibia
  • Place transfixing pin through calcaneous
  • Build Delta Frame
  • Pull traction under fluoroscopic control, tighten frame
  • AO ASIF Delta Frame Technique
  • Adjustable Large Fixator Technique

Pilon Fracture Small Ring Ex. Fix Technique

  • Transverse fx in the coronal plane can not be fixed with olive wires and must be fixed with canulated screws. 
  • OSI table with beanbag. 
  • Fibula should be fixed first with plate or pulled out to length percutaneous and pinned to tibal with K-wires. 
  • 3-4 ring frame.  Ring at--ankle joint;  Just proximal to any shaft extension; mid-tibial; level of fibular head.  Proximal rings fixed together with threaded rod. 
  • First place transverse wire at fibular head. 
  • Attach prox. Ring,  parallel to knee joint, collinear with intact shaft. 
  • Schantx pin into prox tibia and attached to prox ring. 
  • Additional wires/pins to achieve two levels of fixation at each ring. 
  • Next achieve articular reduction.  Place olive wires/cannulated screws per CT planning.  Mini-open reduction if needed/bone graft as indicated  AT least 3-4 olive wires to maintain reduction. 
  • Olive wire syndesmosis if indicated. 
  • Final wire is transverse  reference wire placed just anterior to fibula, parallel to joint @1cm proximal to joint. 
  • Connect distal ring to reference wire.  Then attach remainder of wires using spaces as needed. 
  • Tension wires. 
  • Connect distal and proximal rings.   

Pilon Fracture ORIF Complications

Pilon Fracture ORIF Follow-up care

  • Post-op:
  • 7-10 Days:
  • 6 Weeks:
  • 3 Months:
  • 6 Months:
  • 1Yr:

Pilon Fracture ORIF Outcomes

Pilon Fracture ORIF Review References

  • Rockwood and Greens
  • Patterson MJ, Cole JD. Two-staged delayed open reduction and internal fixation of severe pilon fractures. J Orthop Trauma. 1999 Feb;13(2):85-91.
  • Sirkin M, Sanders R, DiPasquale T, Herscovici D Jr. A staged protocol for soft tissue management in the treatment of complex pilon fractures. J Orthop Trauma. 1999 Feb;13(2):78-84
  • °