Abstract
Tibial Pilon fractures pose a difficult management problem. For logical fracture treatment, precise understanding of the 3-D anatomy is essential.
We have studied a consecutive series of 126 pilon fractures. Digitised X-rays and CT scans were analysed using a CAD programme.
We have defined six main fragments at the articular surface, their relative frequency and their proportion: Anterior (A) present in 89%, 28% of area. Posterior (P) present in 89%, 40% of area. Medial (M) present in 74%, 29% of area. Anterolateral (AL) present in 34%, 8% of area. Posterolateral (PL) present in 21%, 9% of area. Die-punch (DP) present in 43%, 4% of area.
The primary fracture line varied in orientation from coronal (93%) to sagittal (7%), in contrast to the classic description.
Within those cases where the primary fracture line was coronal we found hitherto undescribed variations in the articular pattern, there being ‘T’, ‘V’, ‘Y’ and pure split fractures with respect to the medial fragment. Fractures which displace into varus show a “T” configuration, those in valgus a “Y” or “V” configuration, (p < 0.001). Fractures with no coronal mal-alignment produce a talo-fibular joint disruption.
Once recognised these different articular patterns require individual techniques for anatomic reduction and fixation.
The abstracts were prepared by Mr J. L. Barrie. Correspondence should be addressed to Mr J. L. Barrie, BOFSS Editor, Department of Orthopaedic Surgery, Blackburn Royal Infirmary, Blackburn, Lancashire BB2 3LR.
