pilon fracture classification radiology

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Characteristics and proposed classification system of posterior pilon fractures. The treatment of this fracture pattern has been increasingly reported. The cause of these injuries is frequently violent, and… First described by Destot 35 in 1911, ankle fractures that involve the weight-bearing articular surface, or floor, of the distal tibia are known as pilon fractures. MATERIALS AND METHODS: After institutional review board approval, we retrospectively reviewed consecutive CT scans with calcaneal or pilon fractures from 5 years at a level 1 trauma center. Palma J, Villa A, Mery P, Abarca M, Mora A, Peña A, Urrutia J, Filippi J. J Am Acad Orthop Surg. NLM By continuing to use this website you are giving consent to cookies being used. A pilon fracture is a fracture of the distal tibia involving the tibial plafond. Therefore, the aim of this study was to Actually, pilon fractures are classified according to AO and Ruedi Allgower classification systems based on X-rays. History and etymology. [email protected]. A 'pilon' fracture is any fracture of the distal tibia which involves the articular surface of the tibia - also known as the 'tibial plafond' Ankle - 'Pilon' fracture - Lateral Hover on/off image to show/hide findings Ankle - 'Pilon' fracture - Lateral Using the AO classification system the average K weighted value among the five reviewers was 0,51; using Ruedi Allgower classification it was 0,50 and using the new classification system it was 0,88 (p<0.0005). to maintaining your privacy and will not share your personal information without Cases were presented to the same evaluators in a random sequence after a 6-week interval to determine intraobserver agreement. “The operative treatment of intra-articular fractures of the lower end of the tibia.” Clin Orthop Relat Res (138): 105-110.  |  Pilon is french word for pestle,an instrument used for crushing or pounding, 3. Radiology Department of the Rijnland Hospital, Leiderdorp, the Netherlands. Cases were presented to the same evaluators in a random sequence after a 6-week interval to determine intraobserver agreement.  |  Epub 2019 May 15. NIH The classification of extraarticular fractures has been less controversial, perhaps because they have been the subject of fewer studies than have intraarticular fractures. Epub 2018 Feb 19. Pilon fractures may be considered high-energy ankle fractures. With this type of injury, the other bone in the lower leg, the fibula, is frequently broken as well. First described by Destot 35 in 1911, ankle fractures that involve the weight-bearing articular surface, or floor, of the distal tibia are known as pilon fractures. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. Failure to identify this fracture pattern has led to poor clinical outcomes and persistent talar subluxation. There are also associated fractures of the talar dome and tip of the lateral malleolus. METHODS: One hundred and ten cases (107 patients) of Pilon fractures classified by the four-column theory and treated by ORIF, were reviewed. Curr Rev Musculoskelet Med. Epub 2010 Jul 6. The Weber ankle fracture classification (or Danis-Weber classification) is a simple system for classification of lateral malleolar fractures, relating to the level of the fracture in relation to the ankle joint, specifically the distal tibiofibular syndesmosis.It has a role in determining treatment. Letter to the Editor concerning "Pilon fractures: A new classification system based on CT-scan" by Danilo Leonetti, *, Domenico Tigani (2017). However, classification of Rüedi-Allgöwer bases only on the X-ray radiogragh, lack of other radiological … For information on cookies and how you can disable them visit our Privacy and Cookie Policy. According to the four-column classification scheme, lateral column of 85 cases, posterior column of 66 cases, medial column of 77 cases, and anterior column of 61 cases are involved. Classification. These can be challenging to manage, especially when associated with significant soft-tissue injury. 43A: extra-articular – most would not recognise these as pilon fractures, although in some series non-articular fractures are included and it can be difficult to tell how many were articular 2. 800-638-3030 (within USA), 301-223-2300 (international) Methods One hundred and ten cases (107 patients) of Pilon fractures classified by the four-column theory and treated by ORIF, were reviewed. Department of Radiology, Central Military Hospital, U Vojenske´ ... discrimination between posterior malleolar and pilon fractures remains difficult [30]. Failure to identify this fracture pattern has led to poor clinical outcomes and persistent talar subluxation. Pilon fractures affect the bottom of the shinbone (tibia) at the ankle joint. Your message has been successfully sent to your colleague. Pilon fractures 1. Despite the best treatment, patients sustaining high-energy pilon fractures generally do not return to their previous state of general health or function. Type 3. J Foot Ankle Surg. access full text with Ovid®. 2017 Aug;120(8):632-639. doi: 10.1007/s00113-017-0363-9. CT scan classification; Interobserver agreement; Pilon fractures; Reliability; Treatment-oriented classification. Type IV is a fracture through all three elements of the bone, the growth plate, metaphysis and epiphysis. Registered users can save articles, searches, and manage email alerts. METHODS: One hundred and ten cases (107 patients) of Pilon fractures classified by the four-column theory and treated by ORIF, were reviewed. The Rüedi and Allgöwer classification of pilon fractures. Aim of the study is to (1) propose a new classification system based on CT scan; (2) to check the prognostic value of this classification and (3) to evaluate its reliability and (4) … HHS Injury. This study demonstrated that the new classification system is prognostic, reliable and reproducible. by the American Academy of Orthopaedic Surgeons. References: Melenevsky, Y., et al. This site needs JavaScript to work properly. ... Radiographic features. COVID-19 is an emerging, rapidly evolving situation. Bonin, 11 in 1950, described the same fracture as a “plafond” fracture because the fracture disrupted the roof of the ankle joint. The purpose of this study was to report our outcomes following fixation of this posterior pilon fracture and to describe a novel classification system to help guide operative planning and fixation. – Determined by fracture pattern and “primary” injury Pilon Fractures • Post‐op Care – Make it protocol – Strict elevation post‐op: 23 hrs/day Data is temporarily unavailable. Obviously there is some potential overlap with the more severe malleolar fractures; pilon fractures are usually understood to be those with involvement of the central plafond, although this has not been formally defined. Ruedi and Allgower Classification of Pilon Fractures. Type 2. All fractures were classified according to AO, Ruedi Allgower and new proposed classification system by 5 surgeons. What Is the Most Reliable Classification System to Assess Tibial Pilon Fractures? Explanation. KEY FACTS • The tibial pilon fracture is a rare, yet devastating injury. Pilon fractures in the distal tibia result from axial forces that can range from low to high energy and produce a spectrum of articular and metaphyseal injuries. Pilon fractures may be considered high-energy ankle fractures. Although both extra-articular and intra-articular patterns occur with varying severity, the common concern in all of these injuries is the associated soft tissue injury. doi: 10.1097/MD.0000000000014133. The distal tibial fracture would be designated at “4.3” (e.g., 43-C2) injury, followed by the type and group classification above. These classifications are less reproducible and do not provide necessary information for proper surgical planning. The aim of this study is to: (1) propose a new classification system for the pilon fractures based on the CT scan, useful for the pre-operative surgical planning; (2) check the prognostic value of this classification, and (3) evaluate its reliability and (4) reproducibility. “Talar Fractures and Dislocations: A Radiologist’s Guide to Timely Diagnosis and Classification.” According to the four-column classification scheme, lateral column of 85 cases, posterior column of 66 cases, medial column of 77 cases, and anterior column of 61 cases are involved. A pilon fracture is a type of break that occurs at the bottom of the tibia (shinbone) and involves the weight-bearing surface of the ankle joint. However, an independent assessment has not been done. From the Department of Orthopaedic Surgery, School of Medicine, Pontificia Universidad Catolica de Chile (Dr. Palma, Dr. Villa, Dr. Mery, Dr. Abarca, Dr. Mora, Dr. Peña, Dr. Urrutia) and the Foot and Ankle Division, Department of Orthopedic Surgery, Clinica Las Condes, (Dr. Filippi), Santiago, Chile. Publicationdate 2012-08-23. [Pilon fractures : Review of diagnostics and classification]. When the fibula was fractured, nearly 70% were type C complete articular fractures and over half were type C3, the most comminuted. Bonin, 11 in 1950, described the same fracture as a “plafond” fracture because the fracture disrupted the roof of the ankle joint. The new classification system demonstrated substantial interobserver and intraobserver agreement between evaluators with different levels of expertise in the management of pilon fractures. 800-638-3030 (within USA), 301-223-2300 (international). Unfallchirurg. Paris, France: Masson & Cie, 1949. A New Classification System for Pilon Fractures Based on CT Scan: An Independent Interobserver and Intraobserver Agreement Evaluation. Log in to view full text. Registered users can save articles, searches, and manage email alerts. Actually, pilon fractures are classified according to AO and Ruedi Allgower classification systems based on X-rays. 2020 Mar 1;28(5):208-213. doi: 10.5435/JAAOS-D-19-00390. He is now 3 weeks from injury and … There was no notable difference between the foot and ankle surgeons and orthopaedic surgery residents in the interobserver and intraobserver agreement. Fractures that involve the posteromedial plafond extending to the medial malleolus have been described previously in small case series. To find in-depth information on ankle fractures, please read Ankle Fractures (Broken Ankle).. A pilon fracture is a type of break that occurs at the bottom of the tibia (shinbone) and involves the weight-bearing surface of the ankle joint. Pilon fractures affect the bottom of the shinbone (tibia) at the ankle joint. Some error has occurred while processing your request. Interobserver and intraobserver variations in tibial pilon fracture classification systems. Journal of the American Academy of Orthopaedic Surgeons: JAAOS - Journal of the American Academy of Orthopaedic Surgeons28(5):208-213, March 1, 2020. Wolters Kluwer Health Notes. A good fracture classification system should provide a suitable description of the fractures to facilitate communication between surgeons, show adequate interobserver agreement, guide surgical decision-making, and offer a prognosis for pertinent outcomes in different groups of patients [8, 9, 19].Several classification systems have been suggested for tibial pilon fractures; however, the … In addition to the classification of Rüedi and Allgöwer, the classification of pilon fractures has been carried out using the AO classification. “Talar Fractures and Dislocations: A Radiologist’s Guide to Timely Diagnosis and Classification.”  |  Historical perspective The term”tibial pilon”was first used by DESTOT in 1911,likening the pilon to the pestle. When including the II and III subtypes, the overall agreement was still substantial, with a κ value of 0.61 (95% confidence interval: 0.58 to 0.64). O BENGALURE 2. According to the four-column classification scheme, lateral column of 85 cases, posterior column of 66 cases, medial column of 77 cases, and anterior column of 61 cases are involved. Rev Chir Orthop Reparatrice Appar Mot. The kappa coefficient (κ) was used to determine agreement among evaluators. Typically high energy injuries and occur as a result of an axial loading which drives the talus into the tibial plafond. Correspondence to Dr. Palma: [email protected]. (2015). For more information, please refer to our Privacy Policy. Seventy-one cases of acute pilon fracture were retrospectively collected. 2017 Oct;48(10):2311-2317. The intraobserver agreement was substantial when considering the main fracture categories (I, II, III, or IV), with a κ value of 0.78 (confidence interval: 0.72 to 0.84), and full agreement at the type level was observed in 76% (324/426) of evaluations. 2020 Jan-Feb;59(1):48-52. doi: 10.1053/j.jfas.2019.07.002. Lippincott Journals Subscribers, use your username or email along with your password to log in. may email you for journal alerts and information, but is committed OBJECTIVE: To examine the association between tibial pilon and calcaneal fracture classification and tendon entrapment or dislocation. Description. If you're not a subscriber, you can: You can read the full text of this article if you: Institutional members When the fibula was intact, 58% of fractures were partial articular type B. Please enable scripts and reload this page. 2019 Jan;98(3):e14133. A new pilon fracture classification system based on CT scan data was recently published, showing almost perfect interobserver and intraobserver agreement among the authors who developed it. (OBQ05.93) A 32-year-old man sustains a pilon fracture which is treated initially with a spanning external fixator, as shown in figure A. Fractures were classified by six evaluators (three foot and ankle surgeons and three orthopaedic surgery residents) using CT scans according to the morphological grading of the new pilon fracture classification system developed by Leonetti et al. your express consent. Notice that the epiphyseal fracture is in the sagittal plane, the fracture through the growth plate is in the axial plane and the metaphyseal fracture is in the coronal plane. None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Palma, Dr. Villa, Dr. Mery, Dr. Abarca, Dr. Mora, Dr. Peña, Dr. Urrutia, and Dr. Filippi. These fractures are also named triplane fractures. The first sub-grouping is on the degree of cntinuity between diaphysis and metaphysis: 1. Posterior pilon fracture is a common type of intraarticular fracture encountered in clinical practice. Zhang J, Wang H, Pen C, Qu WC, Duan L, Ren J, Li L, Liu Z, Sun T. Medicine (Baltimore). After recovery from pilon fractures, many patients continue to have debilitating pain and ankle stiffness. Keywords: 1998. There is a comminuted distal tibial fracture extending into the tibial plafond, representing a Pilon fracture. Clinical and radiographic evaluation were performed at a mean follow-up of 36 months. 43B: partial articular fractures with some connection between part of the joint surface and the diaphysis - again, some series appear to include th… Prospective studies should be done to evaluate its prognostic value and utility in clinical practice. Explanation. Int Orthop. 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