[ORT-L] pilon frx - Orthopedics Forum


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[ORT-L] pilon frx

orthauma at hotmail
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Dec 26, 2007, 1:50 PM

Post #1 of 5 (634 views)
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[ORT-L] pilon frx	Can't Post

dear list
this is gunshot injury Gustillo 3c from 2 mo, was debrided and vanco+genta beads with ex-fix and grafting tibialis posterior artery
loss of soft tissue in antero medial aspect of ankle was covered by plastic surgeon/ after many debridments/ after about 35 day by split thick graft
now labs ok
from ur experience what best way to do the ankle arthrodesis here?what about the skin graft??
retrograde nailing with graft
or shortening tibia(by resection comminuted section) to gain union and later lenghthening
or else...

regards

Firas
_________________________________________________________________
Don't get caught with egg on your face. Play Chicktionary!
http://club.live.com/chicktionary.aspx?icid=chick_wlhmtextlink1_dec

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1.jpg (71.0 KB)

2.jpg (69.0 KB)

william.obremskey at Vanderbilt
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Dec 26, 2007, 3:05 PM

Post #2 of 5 (634 views)
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RE: [ORT-L] pilon frx [In reply to]	Can't Post

Posterolateral approach to ankle with patient prone and use a proximal humerus blade plate and auto graft with posterior ICBG.

________________________________

From: ORT-L-owner@www2.aaos.org on behalf of Firas .
Sent: Wed 12/26/2007 1:50 PM
To: ort-l@www2.aaos.org
Subject: [ORT-L] pilon frx

dear list
this is gunshot injury Gustillo 3c from 2 mo, was debrided and vanco+genta beads with ex-fix and grafting tibialis posterior artery
loss of soft tissue in antero medial aspect of ankle was covered by plastic surgeon/ after many debridments/ after about 35 day by split thick graft
now labs ok
from ur experience what best way to do the ankle arthrodesis here?what about the skin graft??
retrograde nailing with graft
or shortening tibia(by resection comminuted section) to gain union and later lenghthening
or else...

regards

Firas

________________________________

Don't get caught with egg on your face. Play Chicktionary! Check it out! <http://club.live.com/chicktionary.aspx?icid=chick_wlhmtextlink1_dec>

nswolfso at usc
New User

Dec 26, 2007, 4:48 PM

Post #3 of 5 (634 views)
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Re: [ORT-L] pilon frx [In reply to]	Can't Post

My choices:

Circular ( Ilizarov) frame in both
Align everything and let it heal.
If no healing:
Combination of acute shortening ( about 4-5 cm) and proximal osteotomy with bone transport , than
a If no pilon left: Tibio-Talar fusion
b. If pilon in place, depends on the size of the distal fragment , may salvage ankle joint ( some ROM, but will have stiffness.

It will take about 1 year to achieve full length and union.

Nikolaj Wolfson, MD, FRCSC
Assistant Professor of Orthopaedic Surgery
Department of Orthopaedic Surgery
Keck School of Medicine
University of Southern California
nswolfso@usc.edu
(323) 226-7346 phone
http://www.usc.edu/medicine/orthopaedic_surgery

----- Original Message -----
From: "Firas ." <orthauma@hotmail.com>
Date: Wednesday, December 26, 2007 1:57 pm
Subject: [ORT-L] pilon frx
To: ort-l@www2.aaos.org

> dear list
> this is gunshot injury Gustillo 3c from 2 mo, was
> debrided and vanco+genta beads with ex-fix and grafting tibialis
> posterior artery
> loss of soft tissue in antero medial aspect of ankle was covered
> by plastic surgeon/ after many debridments/ after about 35 day by
> split thick graft
> now labs ok
> from ur experience what best way to do the ankle arthrodesis
> here?what about the skin graft??
> retrograde nailing with graft
> or shortening tibia(by resection comminuted section) to gain union
> and later lenghthening
> or else...
>
> regards
>
> Firas
> _________________________________________________________________
> Don't get caught with egg on your face. Play Chicktionary!
> http://club.live.com/chicktionary.aspx?icid=chick_wlhmtextlink1_dec
---
[This E-mail scanned for viruses by Declude Virus]

jjbrooksmd at gmail
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Dec 26, 2007, 5:17 PM

Post #4 of 5 (634 views)
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Re: [ORT-L] pilon frx [In reply to]	Can't Post

i had a very similar case with big medial soft tissue and defect not
long ago and i agree completely with dr. obremskey. my patient had
less bone loss, though (but not by much) you can also take whole
distal fibula from the fracture level and use as strut autograft in
the arthrodesis site - great technique. some BMP-2 (Infuse) if
available might enhance incorporation/healing and according to alan
jones' group might be as good as autograft in tibias (although that
study was under different circumstances).

this all assumes you have a healthy soft tissue bed, negative
cultures from the site (bone biopsy preop maybe), normal ESR/CRP, and
a healthy NONSMOKING patient motivated for the long haul!

jeff brooks
stamford, ct

On Dec 26, 2007, at 7:48 PM, Nikolaj Wolfson wrote:

> My choices:
>
> Circular ( Ilizarov) frame in both
> Align everything and let it heal.
> If no healing:
> Combination of acute shortening ( about 4-5 cm) and proximal
> osteotomy with bone transport , than
> a If no pilon left: Tibio-Talar fusion
> b. If pilon in place, depends on the size of the distal fragment ,
> may salvage ankle joint ( some ROM, but will have stiffness.
>
> It will take about 1 year to achieve full length and union.
>
>
>
> Nikolaj Wolfson, MD, FRCSC
> Assistant Professor of Orthopaedic Surgery
> Department of Orthopaedic Surgery
> Keck School of Medicine
> University of Southern California
> nswolfso@usc.edu
> (323) 226-7346 phone
> http://www.usc.edu/medicine/orthopaedic_surgery
>
>
> ----- Original Message -----
> From: "Firas ." <orthauma@hotmail.com>
> Date: Wednesday, December 26, 2007 1:57 pm
> Subject: [ORT-L] pilon frx
> To: ort-l@www2.aaos.org
>
>> dear list
>> this is gunshot injury Gustillo 3c from 2 mo, was
>> debrided and vanco+genta beads with ex-fix and grafting tibialis
>> posterior artery
>> loss of soft tissue in antero medial aspect of ankle was covered
>> by plastic surgeon/ after many debridments/ after about 35 day by
>> split thick graft
>> now labs ok
>> from ur experience what best way to do the ankle arthrodesis
>> here?what about the skin graft??
>> retrograde nailing with graft
>> or shortening tibia(by resection comminuted section) to gain union
>> and later lenghthening
>> or else...
>>
>> regards
>>
>> Firas
>> _________________________________________________________________
>> Don't get caught with egg on your face. Play Chicktionary!
>> http://club.live.com/chicktionary.aspx?icid=chick_wlhmtextlink1_dec
> ---
> [This E-mail scanned for viruses by Declude Virus]
>

---
[This E-mail scanned for viruses by Declude Virus]

nswolfso at usc
New User

Dec 27, 2007, 3:11 PM

Post #5 of 5 (609 views)
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Re: [ORT-L] pilon frx [In reply to]	Can't Post

I am attaching my case , 18 years old. 7 cm bone defect, GSW. Frame is out a week ago. Very satisfying result.
Age and other host factors are no doubts of major significance.

Nikolaj Wolfson, MD, FRCSC
Assistant Professor of Orthopaedic Surgery
Department of Orthopaedic Surgery
Keck School of Medicine
University of Southern California
nswolfso@usc.edu
(323) 226-7346 phone
http://www.usc.edu/medicine/orthopaedic_surgery

----- Original Message -----
From: Jeff Brooks <jjbrooksmd@gmail.com>
Date: Wednesday, December 26, 2007 5:22 pm
Subject: Re: [ORT-L] pilon frx
To: ORT-L@www2.aaos.org

> i had a very similar case with big medial soft tissue and defect
> not
> long ago and i agree completely with dr. obremskey. my patient had
>
> less bone loss, though (but not by much) you can also take whole
> distal fibula from the fracture level and use as strut autograft
> in
> the arthrodesis site - great technique. some BMP-2 (Infuse) if
> available might enhance incorporation/healing and according to
> alan
> jones' group might be as good as autograft in tibias (although
> that
> study was under different circumstances).
>
> this all assumes you have a healthy soft tissue bed, negative
> cultures from the site (bone biopsy preop maybe), normal ESR/CRP,
> and
> a healthy NONSMOKING patient motivated for the long haul!
>
> jeff brooks
> stamford, ct
>
>
>
> On Dec 26, 2007, at 7:48 PM, Nikolaj Wolfson wrote:
>
> > My choices:
> >
> > Circular ( Ilizarov) frame in both
> > Align everything and let it heal.
> > If no healing:
> > Combination of acute shortening ( about 4-5 cm) and proximal
> > osteotomy with bone transport , than
> > a If no pilon left: Tibio-Talar fusion
> > b. If pilon in place, depends on the size of the distal fragment
> ,
> > may salvage ankle joint ( some ROM, but will have stiffness.
> >
> > It will take about 1 year to achieve full length and union.
> >
> >
> >
> > Nikolaj Wolfson, MD, FRCSC
> > Assistant Professor of Orthopaedic Surgery
> > Department of Orthopaedic Surgery
> > Keck School of Medicine
> > University of Southern California
> > nswolfso@usc.edu
> > (323) 226-7346 phone
> > http://www.usc.edu/medicine/orthopaedic_surgery
> >
> >
> > ----- Original Message -----
> > From: "Firas ." <orthauma@hotmail.com>
> > Date: Wednesday, December 26, 2007 1:57 pm
> > Subject: [ORT-L] pilon frx
> > To: ort-l@www2.aaos.org
> >
> >> dear list
> >> this is gunshot injury Gustillo 3c from 2 mo, was
> >> debrided and vanco+genta beads with ex-fix and grafting tibialis
> >> posterior artery
> >> loss of soft tissue in antero medial aspect of ankle was covered
> >> by plastic surgeon/ after many debridments/ after about 35 day by
> >> split thick graft
> >> now labs ok
> >> from ur experience what best way to do the ankle arthrodesis
> >> here?what about the skin graft??
> >> retrograde nailing with graft
> >> or shortening tibia(by resection comminuted section) to gain union
> >> and later lenghthening
> >> or else...
> >>
> >> regards
> >>
> >> Firas
> >> _________________________________________________________________
> >> Don't get caught with egg on your face. Play Chicktionary!
> >> http://club.live.com/chicktionary.aspx?icid=chick_wlhmtextlink1_dec
> > ---
> > [This E-mail scanned for viruses by Declude Virus]
> >
>
> ---
> [This E-mail scanned for viruses by Declude Virus]
>
>

Attachments:

OTA my Case Dec 2007.ppt (9.03 MB)

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