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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
97° CONGRESS OF THE PIEDMONTESE-LIGURIAN-LOMBARD SOCIETY OF ORTHOPEDICS AND TRAUMATOLOGY (SPLLOT) - II (Alba, September 22-23, 2000)
Minerva Ortopedica e Traumatologica 2000 October;51(5):313-20
Technical difficulties in traumatology: pilon tibial fractures. Complications and treatment
Lagalla F., Novarese E., Crova M., Sandrucci G., Flimmengo M.
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The tibial pilon fractures are rare lesions, but often have severe complications since they are serious injuries; the authors after a review of the literature discuss some of the important technical difficulties and suggest a suitable treatment. The more common complication of tibial pilon fractures can be graded according to the timing of their appearance: A) intraope-rative, resulting from a mistaken evaluation of the fracture or incorrect surgical techniques. This mistake can be avoided using the Redi and AO classification of distal tibial fractures in decision making, selecting an appropriate surgical approach and having a careful radiological assessment. B) Early, as a result of the damage of soft tissues or post surgical woundedge necrosis; the treatment is surgical drebidement of all necrotic tissues and plastic surgery; infections are the most serious complication of trauma and they should be treated aggressively with repeat surgical debridements and appropriate antibiotic coverage. C) Late, delayed union and non union that could be treated with bone grafting and stable internal fixation or external skeleton fixation; varo-valgus deformity treated with corrective osteotomy; post-traumatic arthritis for which it is necessary to perform arthrodesis of the ankle; joint stifness can be prevented by early mobilization and in some cases by arthroscopic technique.