ORIF open pilon fracture – AO C2; complex metaphyseal
52 year old herion/cocaine addict transferred from UBC, having fallen off a ladder. Open wound laterally, which in fact was from the fibula. Xrays demonstrated a comminuted metaphysis, but the articular surface was not that badly smashed. This looked worse intraoperatively.
Positioning: Fracture table with calcaneal traction pin to get the thing out to length and so that we could both work at the same time – someone exposing the tibia, the other the fibula.
The exposure to the fibula is the standard thing. The exposure to the tibia is a curved incision, coming along the medial side of the crest, then curving gently over the medial malleolus; This brings you down upon tib ant; and the tibia is exposed by incising down to bone along the medial aspect of tib ant, then lifting the anterior compartment off subperiosteally.
The metaphyseal bone was totally smashed. We started with the metaphysis rather than the articular surface, then built our way down.