PILON FRACTURE OF THE TIBIA [Case 2] · Postero-Medial + Lateral Approach

The treatment of pilon fractures requires precise three-dimensional planning, anatomical joint restoration, and stable fixation strategies for multiple fragments.

This training presents the complete management of a complex pilon fracture using a posteromedial approach combined with a lateral approach, with osteosynthesis based on indirect reduction, posterior and medial support plates, and anteroposterior percutaneous fixation, all demonstrated in detail from a surgical perspective.

TRAINING FOCUS

• CT planning and three-dimensional reconstruction.
• Posteromedial approach to the distal tibia.
• Management of posteromedial shear of the tibial pilon.
• Anatomical preservation of the posterior tibial tendon and neurovascular bundle.
• Posterior fixation with a titanium plate.
• Reduction strategies through the implant.
• Percutaneous fixation of the posterior malleolus.
• Lateral approach to the distal fibula.
• Management of segmental fractures and rotated fragments.
• Alignment correction and restoration of physiological valgus of the fibula.
• Three-dimensional fixation in complex articular fractures.

DETAILED CONTENT

• Structured CT Planning: Axial interpretation and 3D reconstruction for defining the surgical sequence and identifying key fragments.
• Anatomical Posteromedial Approach: Access technique with preservation of the posterior tibial tendon, flexor retinaculum, and superficial venous structures.
• Saphenous Vein and Soft Tissue Protection: Blunt dissection and tissue preservation strategies aiming for reduced postoperative edema.
• Implant-Guided Reduction: Practical application of reduction through the plate and the cortical screw positioned over the apex of the shear.
• Posterior Tibial Pilon Fixation: Placement of a posteromedial plate and three-dimensional stabilization of articular fragments.
• Three-Dimensional Reduction Control: Deep palpation and fine-tuning adjustment methods for reduction to avoid hidden incongruities.
• Anteroposterior Percutaneous Fixation: Minimally invasive technique for simultaneous stabilization of the posterior malleolus and anterolateral fragment.
• Strategies for Complex Fibula Fractures: Management of rotated segmental fragments and intraoperative adaptation of the fixation tactic.
• Varus Correction and Physiological Valgus Recovery: Progressive adjustments of plates and screws for restoration of the anatomical axis.
• Anatomical Layered Closure: Muscle preservation and tissue reconstruction with less surgical aggression.

MATERIAL INCLUDED

Detailed PDF: The PDF presents complete CT planning of the fracture, analysis of articular fragments, strategic sequence of surgical approaches, implant positioning, biomechanical principles used in tibial pilon reduction, and discussion of intraoperative decisions related to posteromedial fixation, percutaneous stabilization, and distal fibula reconstruction.

Deepen your decision-making in complex ankle articular fractures and master tibial pilon fixation strategies with a dual approach and three-dimensional stabilization.