title: A modified posteromedial approach combined with extensile anterior for the treatment of complex tibial pilon fractures (AO/OTA 43-C).
abstract: The anterior approaches that have been described for open reduction internal fixation of multifragmentary pilon fractures are designed to reconstruct the comminuted and impacted anterior articular surface onto a stable posterior column. Thus, reduction of the posterior column, particularly proper length, is critical. There are differing opinions of how best to surgically approach the posterior pilon fracture. There is also no clear indication as to the timing of both anterior and posterior reconstructions. Our objectives were (1) to develop a more midline posterior approach that might provide better visualization of the posterior aspect of the posterior column and juxtametaphyseal/diaphyseal parts of the tibia, first on the cadaver and then with patients, and (2) to use this as part of a combined posterior and anterior approach during the same anesthesia for complex tibial pilon fractures (AO/OTA 43-C) in a preliminary study of 6 patients.
authors.affiliation: *Center for Surgery of the Foot & Ankle, Clinique La Colline, Geneva, Switzerland; †Faculté de Médecine, University of Geneva Medical Center, Geneva, Switzerland; ‡Division of Orthopaedics and Trauma Surgery, University Hospitals of Geneva, Geneva, Switzerland; and §Division of Anatomy, University of Geneva Medical Center, Geneva, Switzerland.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Assal
authors.forename: Adrien
authors.initials: A
authors.lastname: Ray
authors.forename: Jean H D
authors.initials: JH
authors.lastname: Fasel
authors.forename: Richard
authors.initials: R
authors.lastname: Stern
mesh_terms: D000328:Adult; D002102:Cadaver; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D018460:Fractures, Comminuted / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013978:Tibial Fractures / Q000601:surgery*