Pilon Fracture ORIF / Ex Fix 27828

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

Pilon Fracture ORIF CPT

• 27828 (open treatment of fracture of weigth bearing articular surface of the distal tibia with internal fixation of both tibia and fibula.
• 20690 (application of uniplane external fixator)
• 20697 (application of multiplane/Ilizarov external fixator)

Pilon Fracture ORIF Indications

Pilon Fracture ORIF Contraindications

Pilon Fracture ORIF Alternatives

Pilon Fracture ORIF Pre-op Planning

• Case Card.

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
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