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Surgical Treatment Approach for Pilon and Talar Dome Fracture

A Case Report

Jin Park MD, PhD, Hyo Beom Lee MD, Gab Lae Kim MD, and Kyu Hyun Yang MD, PhD
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Talar injuries that are associated with pilon fractures include talar body fractures, osteochondral defects, and posterior process talar fractures. Pilon fractures, in combination with talar dome fractures, have not yet been reported in the scientific literature. We report the case of a 15-year-old boy who sustained a pilon fracture with a lateral talar dome fracture. The pilon fracture was initially fixed using a temporary external fixator for soft-tissue care. After the swelling subsided, definitive internal fixation was performed. First, the lateral talar dome fracture was directly reduced and fixed using a small anterolateral approach of the ankle. Then, the intra-articular portion of the pilon fracture was directly reduced using the same anterolateral approach and an additional small anteromedial approach, and the extra-articular metaphyseal portion of the pilon fracture was indirectly reduced. The pilon fracture was finally fixed with an anterolateral distal tibia plate, using a submuscular plating technique through the anterolateral approach and a separate proximal skin incision. A medial distal tibia plate was later added using a subcutaneous plating technique through the anteromedial approach and another proximal skin incision. Both the pilon fracture and the lateral talar dome fracture were addressed simultaneously through a combination of the small anterolateral and anteromedial approaches.

Department of Orthopedic Surgery, College of Medicine, Hallym University, Seoul, Republic of Korea.

Department of Orthopedic Surgery, College of Medicine, Yonsei University, Seoul, Republic of Korea.

Corresponding author: Jin Park, MD, PhD, Department of Orthopedic Surgery, College of Medicine, Hallym University, Kangdong Sacred Heart Hospital, 150 Sung-an-ro, Kangdonggu, Seoul 05355, Republic of Korea. (E-mail: parkjinos@gmail.com)