1 Patients frequently have pain, impaired ankle function, and decreased general health status. However, conclusions regarding the superior choice remain controversial. The ankle is actually less susceptible to arthritis than the hip or knee. A 52-year-old carpenter falls off of a balcony while at work and sustains the injury shown in Figure A. Home; Gallery; Tibial plafond; Upload & Save . The bimalleolar axis was defined as the center of the fibula and the distal part of the tibia. Very interesting case of a typical Osteochondritis Dissecans in the posterior tibial plafond. 3A and 3B). When Tibial Plateau Fractures Are A Pain The tibial plateau is an important weight -bearing part of the body that connects the thighbone (femur) to the shinbone via ligaments. Excision of the diseased osteochondral defect. Open reduction and internal fixation and limited internal fixation combined with an external fixator are 2 of the most commonly used methods of tibial plafond fracture repair. Preoperative radiographs of case 3. a-b The Arrow Head showing the “double contour” sign on AP view indicates the existence of PM fragment. What would be the most appropriate sequence of treatment steps for definitive management of this injury? Two years following surgery, which of the following parameters will most likely predict a poor clinical outcome and inability to return to work? • A true lateral fluoroscopic image is obtained when the posterior and distal femoral condyles are collinear with one another, and the medial and lateral aspects of the tibial plateau are aligned – a bigger bump can be used if the nonoperative leg remains in view, and the leg adducted or abducted to improve the lateral fluoroscopic image. B. 9.1 Anteroposterior radiograph (a) and MRI (b) demonstrating an osteochondral defect in the tibial plafond (OLTP) with a large overlying periarticular cyst Diagnosis is usually made on a CT scan or magnetic resonance imaging (MRI) [ 2, 6 ]. After removing the external fixator and plating the fibula, what would be next step in the operative plan for reduction and fixation of this injury? Varus or valgus deformity, if suspected, can be measured with the frontal tibiotalar surface angle (TTS), formed by the mid-longitudinal tibial axis (such as through a line bisecting the tibia at 8 and 13 cm above the tibial plafond) and the talar surface. All medial malleolar osteotomies showed complete union at 3 months postoperatively. An angle of less than 84 degrees is regarded as talipes varus, and an angle of more than 94 degrees is regarded as talipes valgus. “Pilon,” the French word for pestle, was first used by Etienne Destot in 1911 as an analogy for the mechanical function of the distal tibia on the talus. It contains free information. The preoperative Mikulicz line was calculated by drawing a line between the center of the femoral head and the center of the tibial plafond. Vascular insult is an unlikely cause of os-teochondral injury in the tibial plafond. 1-5 Most studies that report outcomes after these fractures have assessed patients at a single point in time and report an average length of follow up. A 32-year-old man sustains a pilon fracture which is treated initially with a spanning external fixator, as shown in figure A. In past anatomic reports of the tibial plafond attachment of the PITFL, the length, the width, and the size of the attachment of PITFL were varied. Coronal and sagittal CT scan images are shown in Figures D and E. What is the MOST appropriate next step in management in addition to operative irrigation and debridement? Postoperative radiographs demonstrated what appeared to be an anatomic reduction of the fibula and syndesmosis, but with distal translation of the talus with respect to the tibial plafond and an increase in the tibiotalar clear space (Figs. In a pilon fracture, the Chaput fragment typically maintains soft tissue attachment via which of the following structures? Introduction: Osteochondral lesions of the tibial plafond account for approximately 2.6% of osteochondral lesions in the ankle. An x-ray can show if there is an injury to your bones or if the joints in your ankle are out of place. Introduction: Osteochondral lesions of the tibial plafond account for approximately 2.6% of osteochondral lesions in the ankle. When Tibial Plateau Fractures Are A Pain The tibial plateau is an important weight -bearing part of the body that connects the thighbone (femur) to the shinbone via ligaments. In my experience these lesions have a good healing potential without developing a loose body. An x-ray can show if there is an injury to your bones or if the joints in your ankle are out of place. 1,6,7,9,10,19 This study is the first report of the tibial plafond attachment of the PITFL focused on the positional relationship with the articular surface. A similar change from smooth to wavy physeal contour with age is evident in other long bones, such as the femur (see , Figs 4a , , 4c , , 11 ). All patients had a CT scan prior to definitive fixation. It involves the articular surface of the ankle joint. Rüedi and Allgöwer (1979)—The system of Rüedi and Allgöwer is perhaps the most widely used classification of tibial plafond fractures reported in the literature. tibial plafond Radiological image gallery of tibial plafond. View Tools Recall Comm. Guide wire tip should rest just above the tibial plafond, with bent area turned posteriorly. document.write(theYear) | 1b), and FAR (Fig. Open DICOM files . CT image through the tibial plateau shows a fracture of the posterior aspect of the lateral tibial plateau, which is the source of the lipohemarthrosis. Ankle Platform is for Orthopedic Surgeons with special interest in Ankle and Hindfoot. Salisbury NHS Foundation Trust UK Sinding-Larsen-Johannson syndrome is a traction apophysitis involving the inferior pole of the patella, typically affecting individuals age 10–14. 2 Figure 8 Figure 7 Guide Pin Hand Grip Insert tip into canal through awl opening. 1a), FLR (Fig. Although the ligaments are needed to give the ankle its full stability, the bony congruity of the mortise and the talus is a necessary component as well forming the … The patient's BMI is 52 and he smokes 2 packs of cigarettes per day; a clinical photograph of the limb is shown in Figure B. 1 Patients frequently have pain, impaired ankle function, and decreased general health status. The injury is closed, and soft tissues are intact upon arrival. It is also known as Pilon fracture and explosion fracture. The cross angle (α, Fig. Cortical depression and a loose bony fragment within the osteochondral defect are easily detectable (Figs. Tibial plafond Background Posterior pilon, which has drawn attention over re-cent years, is considered as a variant of posterior mal-leolar fracture [1–15]. The term was first given by Hansen et al. Emulating the technique used by Cole to configure tibial plafond fractures, we utilized the axial slice 0.3–0.5 mm below the medial articular surface . Hover on/off image to show/hide findings. He has a 2 cm laceration over the medial ankle with exposed bone and a normal neurovascular exam. The preoperative Mikulicz line was calculated by drawing a line between the center of the femoral head and the center of the tibial plafond. The syndesmosis is the fibrous connection between the fibula and tibia formed by the anterior and posterior tibiofibular ligaments - located at the level of the tibial plafond (French for ceiling) - and the interosseus ligament, which is the thickened lower portion of the interosseus membrane. Tested Concept, Application of an anterolateral pre-contoured plate with distal locking screws to the tibia, Anatomical reduction and stabilization of the tibial articular surface, Application of a medial pre-contoured plate with distal non-locking screws to the tibia, Anatomical reduction and stabilization of the tibial metaphyseal segment, Proximal screw insertion with non-locking screws to distract the metaphyseal fracture comminution, (SBQ12TR.30) In 11 patients (22%), the posterior border of the fibula intersected precisely at the posterior edge of the tibial plafond. Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC. Tap on/off image to show/hide findings. Arthritis of the ankle - wear of the ankle - typically affects younger patients. tibial plafond is less stiff than the talar dome, placing them at risk for osteochondritis disse-cans of the tibial plafond. Using the PACS, the corrected Mikulicz line was drawn by connecting the center of the femoral head and the 62.5% point of the plateau on the whole-leg standing X-ray (green line in Figure 1 ). Follow Radiology Masterclass on Facebook or sign up to our email newsletter to get the latest news and offers. 1,6,7,9,10,19 This study is the first report of the tibial plafond attachment of the PITFL focused on the positional relationship with the articular surface. If a defor-mity above the ankle is suspected, it is generally accepted Most tibial pilon fractures are best approached anteriorly. 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