TIBIAL PILON [CASE 03] Anterolateral and Posteromedial Approaches

This case-based educational module presents a tibial pilon fracture of the ankle managed through detailed operative reasoning and stepwise exposure. The discussion highlights staged decision-making after external fixation, assessment of the soft-tissue envelope, interpretation of CT findings, and the rationale for addressing a displaced anterolateral fragment through an anterolateral approach. Particular attention is given to identification, release, and protection of the superficial peroneal nerve, a structure that may be encountered in the lateral compartment before it travels into the subcutaneous layer during approaches in this region (KB1, page 2510).

The case also demonstrates how fracture morphology influences the reduction sequence, including the use of provisional fixation, implant-assisted reduction, and additional posteromedial exposure when residual displacement remains. In tibial pilon fracture surgery, the reduction and fixation sequence varies according to the fracture pattern, with accurate articular reduction described as a central priority in operative planning (KB3, page 4505). This module is intended for procedural education and critical review rather than independent procedural guidance.

INICLUDED CONTENT

• Case-based operative walkthrough of a tibial pilon fracture of the ankle.
• Discussion of initial external fixation and the limitations of ligamentotaxis in the presence of a displaced fragment.
• Anterolateral approach demonstration with emphasis on superficial peroneal nerve handling.
• Fragment-specific reduction strategy for the anterolateral tibial fragment.
• Posteromedial exposure planning for residual displacement.
• Technical reasoning on clamp placement, plate positioning, screw length, and implant-assisted reduction.
• Educational narration by Dr. Sávio Chami.
• Source content originally in pt-BR, adapted into English for educational description.

TARGET AUDIENCE

• Orthopedic trauma surgeons
• Orthopedic residents
• Trauma fellows
• Foot and ankle surgeons with trauma interest
• Medical educators reviewing fracture reduction strategy
• Operating room team members involved in orthopedic trauma education

EDUCATIONAL NOTICE

This content is intended solely for medical education and procedural review. It does not replace formal surgical training, institutional protocols, specialist supervision, or individualized clinical judgment. No clinical outcome is promised or implied. Human expert review is mandatory before educational or clinical use.