Visualizing access in pilon fractures: A comparative study of eight approaches

Area of Science:

• Orthopedic Surgery
• Anatomy
• Biomechanics

Background:

• Tibial pilon fractures are complex, accounting for 3-10% of tibia fractures.
• Significant soft tissue damage often complicates management.
• Careful preoperative planning and surgical approach selection are crucial.

Purpose of the Study:

• To conduct a cadaveric analysis comparing eight surgical approaches for tibial pilon fractures.
• To evaluate the consistently exposed bone segment and the total exposed bone area for each approach.
• To provide objective data to aid orthopedic surgeons in preoperative planning.

Main Methods:

• Sixteen foot and ankle specimens were used, with each undergoing two approaches (four repetitions per approach).
• Eight approaches were analyzed: anteromedial, anterolateral, lateral, posterolateral, posteromedial, posterior modified posteromedial, anterior modified posteromedial, and medial.
• Exposed bone area was measured using ImageJ software; consistently exposed segments were determined via axial cuts and photographic analysis.

Main Results:

• The anteromedial approach provided the largest exposed bone area (18.36 cm²).
• The anterolateral approach yielded the greatest exposed segment (72°), optimal for Chaput fragment and comminution.
• The posteromedial approach was most effective for the Volkmann fragment.

Conclusions:

• Objective data on exposed area and segment for surgical approaches to tibial pilon fractures were generated.
• This research aids orthopedic surgeons in preoperative planning and decision-making for complex fractures.
• Enhanced understanding of approach capabilities and limitations can improve surgical outcomes.