Entrapped posteromedial structures in pilon fractures.

Area of Science:

• Orthopedic Surgery
• Radiology
• Trauma Medicine

Background:

• Tibial pilon fractures are complex injuries often involving intra-articular extension.
• Posteromedial soft tissue entrapment can complicate surgical management and outcomes.

Purpose of the Study:

• To determine the incidence of posteromedial soft tissue structure interposition in tibial pilon fractures.
• To evaluate the diagnostic utility of computed tomography (CT) in identifying these entrapped structures.

Main Methods:

• Retrospective review of 420 tibial pilon fractures in 394 patients.
• Analysis of preoperative radiographs and CT scans to identify entrapped posteromedial soft tissues.
• Review of medical charts for neurologic deficits and surgical approach details.

Main Results:

• 9.5% of fractures (40/420) had entrapped posteromedial structures.
• The tibialis posterior tendon was the most commonly entrapped structure (95%).
• Radiologists noted entrapped structures in only 20% of cases.

Conclusions:

• CT imaging is valuable for detecting posteromedial soft tissue entrapment in tibial pilon fractures.
• Entrapped tibialis posterior tendon may necessitate a posteromedial surgical approach.
• Failure to identify entrapped structures can lead to poor outcomes, including malreduction and neurovascular compromise.