PMC10432129_01
X-rays at the time of injury (after calcaneal traction) show the tibial pilon fractures (AO/OTA 43c3.3, Ruedi-Allogoer: Type III).
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X-rays at the time of injury showed tibial pilon fractures (AO/OTA 43c3.3, Ruedi-Allgower: Type III; Figure 1).
Exterior view after fixation with an external fixator. Skin necrosis and closed fracture with soft tissue necrosis on the medial side of the lower leg (IC3-MT1-NV1).
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Soft-tissue necrosis with blisters on the medial side of the lower leg (AO soft-tissue classification: IC3-MT1-NV1) was observed (Figure 2), and the patient was referred to our hospital on day 10 of the injury.
3D CT at the time of the injury. (a) Anterior fragments. (b) Medial fragments. (c) Posterolateral fragment.
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A preoperative computed tomography (CT) examination showed that the joint surface was divided into four parts: the anterior fragment (Figures 3(a) and 4(a)), the medial bone fragment (Figures 3(b) and 4(b), the posterolateral bone fragment (Figures 3(c) and 4(c)), and the die-punch fragment (Figure 4(d)).
CT at the time of the injury. (a) Anterior fragments. (b) Medial fragments. (c) Posterolateral fragments. (d) Die-punch fragments.
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A preoperative computed tomography (CT) examination showed that the joint surface was divided into four parts: the anterior fragment (Figures 3(a) and 4(a)), the medial bone fragment (Figures 3(b) and 4(b), the posterolateral bone fragment (Figures 3(c) and 4(c)), and the die-punch fragment (Figure 4(d)).
Exterior view during surgery. (A) Restoration of the debrided articular under direct visualization. (B) After removal of the RSAF (10 cm in height and 8 cm in width with 4 cm pedicle with skin). (C) Covered area of skin loss. (a) Temporary fixation using k-wire. (b) Dissected flap.
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We removed the medial bone fragment from the debrided area and directly visualized the joint surface (Figure 5(a)), which we fixed with a cannulated cancellous screw (CCS). The flap design was enlarged from the area of the damaged defect, measuring approximately 10 cm in length and 8 cm in width (Figure 5(b)).
Post-surgery X-ray and circular external fixators. Rings were placed on the tibia at three locations, and a foot ring was placed on the foot at one location.
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Rings were placed on the tibia at three locations, and a foot ring was placed and fixed on the foot (Figure 6).
X-ray and the exterior of the RSAF one year after surgery.
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X-ray evaluation showed stage 2 arthrosis according to the Takakura ankle osteoarthritis classification (Figure 7).
X-ray 4 years after surgery. Degenerative changes were observed in the articular surface (Takakura ankle osteoarthritis classification: Stage 2).
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Stage 2 arthrosis was present according to the Takakura ankle osteoarthritis classification, but the patient was able to walk without pain (Figure 8).