Concomitant Total Ankle Replacement and Open Reduction and Internal Fixation for a Comminuted Distal Tibial Pilon Fracture: A Case Report.

Abstract

We report a case of an acute comminuted distal tibial pilon fracture treated with open reduction and internal fixation (ORIF) and, concomitantly, total ankle replacement, with a follow-up duration of three years. The patient in this report was informed that data concerning his case would be submitted for publication, and he consented. A seventy-six-year-old male patient presented with a closed, comminuted distal tibial pilon fracture (type C according to the OTA/AO classification1). The injury was a result of a fall from a ladder. The patient initially presented on the day of the injury at his local primary care center. The primary care specialist planned to treat him nonoperatively with the application of an above-knee, non-weight-bearing cast. Because of the proposed lengthy and difficult rehabilitation process, the patient opted to be referred to our tertiary center. There was no sign of neurovascular injury, and the patient’s systemic status was ASA (American Society of Anesthesiologists) grade 2. A radiograph and a CT (computed tomography) scan showed a comminuted distal tibial pilon fracture (type C3 by the OTA/AO classification) and a fibular fracture (Figs. 1, 2, and 3). Treatment options as well as intermediate and long-term outcomes were discussed, and following this, the patient decided to proceed with our experimental option of plating the distal tibial fracture and performing a total ankle replacement, all in one stage. Fig. 1 Preoperative anteroposterior radiograph of the right tibia and fibula demonstrating a comminuted distal tibial pilon fracture and a fibular fracture. The proximal aspect of the tibia and of the fibula appear to be intact. Fig. 2 Preoperative CT scan of the sagittal section of the right tibia demonstrating a comminuted distal tibial pilon fracture involving the …