الفهرس 
ANATOMY OF THE ANKLE JOINTOnly 14 pages are availabe for public view
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Abstract
Intra-articular fractures of the distal aspect of the tibia are amongst the most complex injury of the leg and represent a major treatment challenge. The management of these injuries is controversial and published outcomes vary dramatically from method to method and also from author to author. (William et al,1996)
Everything about these fractures seems uncertain even including the use of the name ’Pilon Fracture’. Mc Cormackdef defines all fractures involving the horizontal weight-bearing surface of the distal tibia as tibial plafond fractures, he defines fractures of the pilon as being fractures of the supra-malleolar portion of the distal tibia which usually extend into the plafond. (Hutson and Zych,1998)
The most commonly accepted definition, however, is that suggested by Tile as being a fracture of the distal tibial metaphysis involving the ankle joint. (Tile,1987)
Tibial plafond fractures include a full spectrum of injury severity, from simple rotational fractures to high-energy axial compression injuries. Plafond fractures are caused predominately by axial loading. When this is the predominant mechanism of injury, they are also referred to as a pilon fractures (pilon is the French word for hammer). Depending on the amount of energy imparted, these injuries frequently result in comminution and impaction of the distal tibial weight-bearing surface. (Marsh and Saltzman ,2001)
As axial load and rotational ankle fractures have different mechanisms and prognoses, they are often managed differently by orthopedists. (Marsh and Saltzman ,2001)
The two primary challenges for successful treatment are restoration of the articular anatomy and optimization of soft tissue healing without complication. (Harris,2000)
The treatment of pilon fractures is more complex than that of indirect ankle fractures, although the goals of treatment remains an anatomic ankle joint that is held to union, other factors are present that influence treatment , the most important of these is the status of the soft tissues, The strong forces required to cause inter articular impaction create significant soft tissue damage. (Marsh and Saltzman,2001)
The surgical treatment of pilon fractures consists of four steps: restoration of the correct length and stabilization of the fibula, reconstruction of the articular surface of the tibia, insertion of cancellous autografts, and stabilization of the medial aspect of the tibia. These principles have to be modified in fractures with severe comminution and soft tissue trauma. (Bonar and Marsh,1993)
Achieving and maintaining anatomic reduction is technically difficult and sometimes impossible. Because internal fixation inevitably leads to localized devitalization of bone, further damage to surrounding soft tissue may follow. The nature and timing of surgery influence soft tissue recovery. (Kerr et al,1990)
These goals should be achieved with a technique that is as minimally invasive as possible. Open reduction and internal fixation with plates and screws, as introduced by Ruedi and Allgower, and reported by several other authors to have provided good results. permits accurate reduction of the articular surface but with a high rate of deep infection ,wound dehiscence, and soft tissue problems. (Blauth et al,2001)
The use of closed reduction and percutaneous fixation technique has reduced the incidence of wound complications. This technique is usually sufficient to reduce and stabilize the articular fragments with use of fluoroscopic or arthroscopic guidance. (Egol et al,2000)
The use of external fixation instead of fixation with plate decreases their complications, the use of external fixation system for high grade tibial plafond injuries (TypeII and TypeIII Rudi and Allgower), this system is effective in stabilization of fractures and limits insult to the soft tissues. (Bone et al,1993)
The best indicator of a potentially good long-term result is a perfect anatomical reconstruction of the joint surface in a well-motivated patient who has been able to move the joint early because of stable internal fixation. (Mast et al,1988)
Pilon fractures can have persistent and devastating consequences on patients’ health and well-being. Certain social, demographic, and treatment variables seem to contribute to this poor outcomes. (Andrew et al,2003)