PMC4335163_01
73-year-old woman with left valgus-angulated pilon fracture with threatened medial skin. (a) Pre-reduction anteroposterior (AP) radiographs (b) Post-reduction AP radiographs revealing failed closed reduction (c-f) Post ED ex-fix AP and lateral radiographs and coronal and sagittal CT scan revealing improved alignment
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F3
A 73-year-old woman presented with a closed comminuted left pilon and distal fibula fracture in valgus angulation with threatening of the medial skin [Figure 3a]. Attempted closed reduction and application of a posterior plaster splint with side gussets was inadequate in maintaining an acceptable reduction to relieve skin pressure [Figure 3b]. Application of a uniplanar ankle spanning external fixator (ED ex-fix) coupled with axial traction and varus force adequately reduced the fracture and prevented the patient from requiring an immediate operative intervention [Figure 3c-f].
PMC4335163_02
24-year-old male with left impacted pilon fracture. (a and b) Pre-reduction anteroposterior (AP) and lateral radiographs (c and d) Post-reduction AP and lateral radiographs revealing failed closed reduction (e and f) Post ED ex-fix AP and lateral radiographs revealing improved alignment
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F4
A 24-year-old hemodynamically unstable polytrauma victim arrived at our institution with a closed comminuted pilon fracture with anterior impaction [Figure 4a and b]. Closed reduction failed to adequately reduce the fracture [Figure 4c and d]. The patient was too medically unstable for the operating room, thus an ED ex-fix was placed, which successfully achieved reduction and temporary stabilization [Figure 4e and f].