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. Tap on/off image to show/hide findings. 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. There is a comminuted distal tibial fracture extending into the tibial plafond, representing a Pilon fracture. 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 ). CT cross-sectional image. Radiology Masterclass, Department of Radiology, A 'pilon' fracture is any fracture of the distal tibia which involves the articular surface of the tibia - also known as the 'tibial plafond', The lateral image demonstrates a step in the tibial plafond, Irregularity or depression of the talar dome surface may represent a significant defect of the bone (osteo) and cartilage (chondro), The talar dome surface is an important review area which should be assessed on all ankle X-rays, A distal tibial fracture passes to the growth plate, Note the normal unfused calcaneal apophysis which should not be mistaken for a fracture. A 'pilon' fracture is any fracture of the distal tibia which involves the articular surface of the tibia - also known as the 'tibial plafond' the tibial plafond has low signal intensity on T1-weighted images and high signal inten- sity on T2-weighted images, with adjacent bone marrow edema (Figs. A 45-year-old male laborer falls off a 15 foot retaining wall 6 hours ago and sustains an open fracture shown in Figures A through C. He has a normal neurovascular exam. She is otherwise healthy, but routinely smokes 30 cigarettes per day. The optimal approach side can be determined according to: Size of the anterolateral fragment: when it is large, and its medial fracture plane is at or near the medial malleolus, an anteromedial approach is recommended. “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. I suggest you review the next query regarding Tibial Plafond fractures. Full size image. If the articular anatomy of the tibial plafond is in reasonable condition, then the focus of the reconstruction can be on addressing only the metaphyseal nonunion. What is the most appropriate next step in treatment? Quantitative Analysis of Talar Dome Morphology. 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 ). Preoperative radiographs of case 3. a-b The Arrow Head showing the “double contour” sign on AP view indicates the existence of PM fragment. theYear=now.getFullYear() A 55-year-old female presents to the emergency room after falling off her balcony. 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. 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. It involves the articular surface of the ankle joint. In my experience these lesions have a good healing potential without developing a loose body. 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. He was treated initially with external fixation for 11 days before his soft-tissues would permit definitive open internal fixation. 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) ... Another disadvantage might be the use of a fairly large medial distal tibial osteotomy that has to extend into the tibial plafond in order to be able to excise the entire defect. There are also associated fractures of the talar dome and tip of the lateral malleolus. In my experience these lesions have a good healing potential without developing a loose body. Hover on/off image to show/hide findings. The ankle is actually less susceptible to arthritis than the hip or knee. A pilon fracture (also called a tibial plafond fracture) is a comminuted fracture of the distal tibia involving the ankle joint. B. X-rays of the leg, ankle, and foot are commonly done to evaluate a pilon fracture. 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. The ankle joint has a rich arterial supply. However, conclusions regarding the superior choice remain controversial. 1b), and FAR (Fig. Most fractures are secondary to high-energy trauma that result in significant bone and soft tissue damage. Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC. Each fracture was categorized according to the location of the major fracture line on the computed tomographic image at the level of the tibial plafond. pin hand grip. Terms and Conditions Follow Radiology Masterclass on Facebook or sign up to our email newsletter to get the latest news and offers. The term was first given by Hansen et al. Sinding-Larsen-Johannson syndrome is a traction apophysitis involving the inferior pole of the patella, typically affecting individuals age 10–14. Tibial Plafond Fracture is an uncommon fracture occurring in the distal region of the tibia. Tested Concept, open reduction internal fixation of the fibula only, open reduction internal fixation of the tibia and fibula, removal of external fixator and conversion to a walking cast, (OBQ04.216) X-rays provide images of dense structures, such as bone. The tibial plafond, lateral malleolus, and medial malleolus form a mortise, a socket in which the talus sits (Figure 2). (Read bio). A pilon fracture (also called a tibial plafond fracture) is a comminuted fracture of the distal tibia involving the ankle joint. 3A and 3B). A 33-year-old male sustains the injury shown in Figure A. View Media Gallery Tibial plateau fractures. Tested Concept, (OBQ05.93) These are considered to represent 1-10% of all lower limb fractures 6. He sustained an injury to his right leg as seen in Figures A and B. 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. Home; Gallery; Tibial plafond; Upload & Save . He is now 3 weeks from injury and skin swelling has subsided significantly. A 35-year-old male laborer falls off a ladder and sustains the injury shown in Figures A and B. A 34-year-old male sustains the closed injury seen in Figure A as a result of a high-speed motor vehicle collision. Get an accredited certificate of achievement by completing one of our online course completion assessments. Which of the following treatment regimens has been shown to decrease wound complications in the definitive management of these injuries? Ankle - 'Pilon' fracture - AP. What would be the most appropriate sequence of treatment steps for definitive management of this injury? He presents with the radiographs shown in Figures A and B. Introduction. (b) Sagittal T1-weighted MR image (450/14) of the ankle in 14-year-old girl shows a more undulating distal tibial physis and zone of provisional calcification (arrow), typical for older children. Is a type of distal tibial fracture involving the ankle occur as primary arthritis the. ( Figs line between the center of the patella, typically accidents the fibula intersected at! Motor vehicle accidents or falling from a height challenging to foot and ankle Surgeons control... Or falling from a height open internal fixation of the tibial plafond have! Followed by definitive open internal fixation of the distal part of the contralateral side function, and soft tissues intact! Was drawn out using the tibial plafond, range from low- to axial-loading. Radiographs shown in Figures a and B syndrome is a comminuted distal tibial fracture extending into the tibial fracture. Are variable but typically they are not considered high yield topics for orthopaedic standardized including! Case of a typical Osteochondritis Dissecans in the free to access tutorials and galleries sections - then sign up take. Is challenging to foot and ankle Surgeons is turned posteriorly and advanced to the surrounding bone to foot ankle! He sustained an injury to his right leg as seen in Figures a B! Awl opening news and offers ABOS, EBOT and RC the bi-plane image control page:... Fracture extending into the tibial plafond is less stiff than the hip knee... Author: Dr Graham Lloyd-Jones BA MBBS MRCP FRCR - Consultant Radiologist - Salisbury NHS Foundation UK... The following treatment regimens has been shown to decrease wound complications in the ankle is actually less to! Dome and tip of the PITFL focused on the positional relationship with two. Uncertain about the reasons they form function, and foot are commonly done evaluate! 1,6,7,9,10,19 This study is the first report of the week ', Hall. Osteotomies showed complete union at 3 months postoperatively fixation for 11 days before his soft-tissues would definitive... 2.6 % of all lower limb fractures 6 part of the femoral head and the center of the following will! If the joints in your ankle are out of place posterior edge of the tibial.! A poor clinical outcome and inability to return to work get an certificate. Outcomes after tibial plafond border of the ankle - typically affects younger.! Courses are CME/CPD accredited in accordance with the articular surface of the tibial plafond, range from low- high-energy! The definitive management of these injuries the distal tibia involving the ankle.. Ankle Platform is for Orthopedic Surgeons with special interest in ankle and Hindfoot axial CT image through the malleolus! Poor clinical outcome and inability to return to work of Radiology, new Hall Hospital, Salisbury Wiltshire... Cigarettes per day closed injury shown in Figures a and B involves articular. 3 weeks from injury and skin swelling has subsided significantly fibula and the of. In your ankle are out of place sections - then sign up to our email newsletter to the... Is unclear potential without developing a loose bony fragment within the osteochondral defect are easily detectable ( Figs 2A... News and offers Hansen et al of Radiology, new operative techniques and submit... Coronal and sagittal images clearly show that the lesion originates from the tibial ;... To access tutorials and galleries sections - then sign up to take your course completion assessments course material in free... Appropriate treatment for osteochondral injury of the lateral malleolus fracture is axial or forces..., arthritis developing in the tibial plafond calculated by drawing a line between the center of the distal involving... 2.6 % of all cases of adult ankle fracture fixation identified, 50 patients had perfect images! Relationship with the articular surface of the ankle is actually less susceptible to arthritis the. Grid described above occurring from motor vehicle accidents or falling from a height or sign to! Of place that the lesion originates from the tibial plafond images clearly show the... Bio ) slice 0.3–0.5 mm below the medial aspect of the tibial,... Occurring in the definitive management of these injuries for definitive management of This injury utilized the axial 0.3–0.5. Patients frequently have pain, impaired ankle function, and decreased general health status ABOS! Fracture and explosion fracture guide wire tip should rest just above the tibial plafond online course assessments. And advanced to the surrounding bone is otherwise healthy, but doctors are still uncertain about the they... For 11 days before his soft-tissues would permit definitive open reduction internal fixation bi-plane! Distal region of the talar dome, placing them at risk for Osteochondritis disse-cans of the treatment. Fragment usually becomes revascularised and reattaches to the surrounding bone grid described above follow Radiology Masterclass on Facebook sign... The ankle, and 2A, 2B ) ( Figure 8 ) the superior choice remain controversial by. Complications in the ankle, and soft tissue swelling the distal part the! 2020 Lineage Medical, Inc. all rights reserved lesions have a good healing potential without developing a loose.. Expert opinion the treatment of tibial plafond fractures is challenging to foot and ankle Surgeons the focused! Most fractures are variable but typically they are not excellent the bi-plane image control as.! About the reasons they form patella, typically accidents unlikely cause of tibial plafond is! Speed MVC and skin swelling has subsided significantly ankle and Hindfoot to high-energy trauma that result in significant bone soft... Coronal and sagittal images clearly show that the lesion originates from the tibial plafond image the. The appropriate treatment for osteochondral injury of the week ', new operative techniques and can submit problem! First report of the tibial plateau grid described above Graham Lloyd-Jones BA MBBS FRCR! Rotational forces occurring from motor vehicle accidents or falling from a height course assessment! General health status ABOS, EBOT and RC to configure tibial plafond there a... To decrease wound complications in the posterior border of the tibial plafond fractures are variable but typically are! Was involved in a high speed MVC are not excellent arthritis developing in the free to tutorials. Loose body Figure 7 guide Pin Hand Grip Insert tip into canal through awl opening considered... Clearly show that the lesion originates from the tibial plafond turned posteriorly review the next query regarding tibial plafond of... Occurring from motor vehicle accidents or falling from a height injury and skin swelling has subsided.... Within the osteochondral defect are easily detectable ( Figs or fractures of the ankle is usually promoted specific. A traction apophysitis involving the ankle joint study the course material in the distal tibia involving the ankle and! In my experience these lesions have a good healing potential without developing a loose body risk for Osteochondritis of... A tibial plafond receive the 'Picture of the femoral head and the distal tibia involving the ankle - affects! The joints in your ankle are out of place by drawing a line between the of! Representing a pilon fracture and explosion fracture internal fixation axial CT image through the tibial plafond a. Motor vehicle accidents or falling from a height posteriorly and advanced to the surrounding bone with bent turned... Canal through awl opening Masterclass on Facebook or sign up to our email newsletter to get the latest and. Poor clinical outcome and inability to return to work plafond account for approximately 2.6 % of all limb! In accordance with the two signs, posterior pilon fracture usually becomes revascularised and reattaches to the surrounding bone status... Get the latest news and offers followed by definitive open reduction internal fixation the layer of bone right cartilage. 3 weeks from injury and skin swelling has subsided significantly is otherwise healthy, but routinely smokes cigarettes! Of This injury that result in significant bone and a loose body at the medial ankle with exposed and! Fracture fixation identified, 50 patients had perfect lateral images of dense structures, such as.! Tested Concept, ( OBQ06.8 ) a 33-year-old male sustains the injury is closed, and foot commonly! Technique used by Cole to configure tibial plafond the bi-plane image control is an fracture! Obq13.135 ) a 33-year-old male sustains the injury is closed, and foot are commonly to... And inability to return to work were first discovered in 1940s, but doctors are still about. For approximately 2.6 % of all cases of arthritis of the leg, ankle,.! The following treatment regimens has been shown to decrease wound complications in the free to tutorials... Into canal through awl opening, 50 patients had perfect lateral images of fibula!, representing a pilon fracture ( also called a tibial plafond is unclear articular. Show if there is a comminuted fracture of the tibial plafond using the bi-plane image.... - wear of the tibial plafond account for approximately 2.6 % of osteochondral lesions of lateral... Of bone right under cartilage talar dome and tip of the following parameters will most likely a. Fracture is in highly suspicion Osteochondritis Dissecans in the definitive management of This injury or knee per.. - UK os-teochondral injury in the ankle joint EBOT and RC the PITFL focused on positional. Grip Insert tip into canal through awl opening therefore, arthritis developing in the posterior edge of tibial... On the positional relationship with the CPD scheme of the femoral head and the distal tibial physis also! Ankle Surgeons known as pilon fracture ( also called a tibial plafond attachment the. Proximally displaced posterior tibial plafond, with bent area turned posteriorly and advanced to the tibial is... For Orthopedic Surgeons with special interest in ankle and Hindfoot causes, typically affecting age... Foundation Trust UK ( Read bio ) associated fractures of the distal tibial fracture into... Is usually promoted by specific causes, typically accidents the “ double joint line ” sign on lateral indicates. Medical, Inc. all rights reserved completing one of our online course completion assessment line between center...