Entrapped posteromedial structures in pilon fractures

Jonathan Garland Eastman, Reza Firoozabadi, Stephen K. Benirschke, David P. Barei, Robert P. Dunbar

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Objectives: To analyze a patient cohort who sustained a tibial pilon fracture and report the incidence of interposed posteromedial soft tissue structures. Design: Retrospective cohort review. Setting: Regional Level 1 Trauma Center. Patients/Participants: About 394 patients with 420 pilon fractures treated between January 2005 and November 2011. Intervention: Each patient?s preoperative radiographs and computed tomography (CT) images were reviewed. The axial and reconstructed images were used in bone and soft tissue windows to identify any posteromedial soft tissue structures incarcerated within the fracture. Main Outcome Measurements: Medical charts reviewed for the presence of preoperative neurologic deficit, separate posteromedial incision, and whether attending radiology CT interpretation noted the interposed structure. Results: 40 patients with 40 fractures (9.5%) had an entrapped posteromedial structure. The tibialis posterior tendon was interposed in 38/40 fractures (95%) and the posterior tibial neurovascular bundle in 4/40 fractures (10%). Preoperative neurologic deficit occurred in 5/40 patients (12%). A posteromedial incision was used in 11/40 fractures (27%). The attending radiology CT interpretation noted the interposed structure in 8/40 fractures (20%). Conclusions: In addition to the osseous injuries, CT imaging can demonstrate the posteromedial soft tissue structures. In our series, the tibialis posterior tendon was commonly incarcerated. In some cases, removal of the entrapped structure(s) may not be possible through the more commonly used anterolateral and anteromedial surgical approaches, and a separate posteromedial exposure may be required. Failure to recognize the presence of an interposed structure could lead to malreduction, impaired tendon function, neurovascular insult, and the need for further surgery.

Original languageEnglish (US)
Pages (from-to)528-533
Number of pages6
JournalJournal of Orthopaedic Trauma
Volume28
Issue number9
DOIs
StatePublished - 2014

Fingerprint

Tomography
Tendons
Neurologic Manifestations
Radiology
Tibial Fractures
Trauma Centers
Bone and Bones
Incidence
Wounds and Injuries

Keywords

  • entrapped structure
  • pilon
  • posteromedial

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Medicine(all)

Cite this

Eastman, J. G., Firoozabadi, R., Benirschke, S. K., Barei, D. P., & Dunbar, R. P. (2014). Entrapped posteromedial structures in pilon fractures. Journal of Orthopaedic Trauma, 28(9), 528-533. https://doi.org/10.1097/BOT.0000000000000046

Entrapped posteromedial structures in pilon fractures. / Eastman, Jonathan Garland; Firoozabadi, Reza; Benirschke, Stephen K.; Barei, David P.; Dunbar, Robert P.

In: Journal of Orthopaedic Trauma, Vol. 28, No. 9, 2014, p. 528-533.

Research output: Contribution to journalArticle

Eastman, JG, Firoozabadi, R, Benirschke, SK, Barei, DP & Dunbar, RP 2014, 'Entrapped posteromedial structures in pilon fractures', Journal of Orthopaedic Trauma, vol. 28, no. 9, pp. 528-533. https://doi.org/10.1097/BOT.0000000000000046
Eastman, Jonathan Garland ; Firoozabadi, Reza ; Benirschke, Stephen K. ; Barei, David P. ; Dunbar, Robert P. / Entrapped posteromedial structures in pilon fractures. In: Journal of Orthopaedic Trauma. 2014 ; Vol. 28, No. 9. pp. 528-533.
@article{d1955e53903f47b8ba893063f58b3cf7,
title = "Entrapped posteromedial structures in pilon fractures",
abstract = "Objectives: To analyze a patient cohort who sustained a tibial pilon fracture and report the incidence of interposed posteromedial soft tissue structures. Design: Retrospective cohort review. Setting: Regional Level 1 Trauma Center. Patients/Participants: About 394 patients with 420 pilon fractures treated between January 2005 and November 2011. Intervention: Each patient?s preoperative radiographs and computed tomography (CT) images were reviewed. The axial and reconstructed images were used in bone and soft tissue windows to identify any posteromedial soft tissue structures incarcerated within the fracture. Main Outcome Measurements: Medical charts reviewed for the presence of preoperative neurologic deficit, separate posteromedial incision, and whether attending radiology CT interpretation noted the interposed structure. Results: 40 patients with 40 fractures (9.5{\%}) had an entrapped posteromedial structure. The tibialis posterior tendon was interposed in 38/40 fractures (95{\%}) and the posterior tibial neurovascular bundle in 4/40 fractures (10{\%}). Preoperative neurologic deficit occurred in 5/40 patients (12{\%}). A posteromedial incision was used in 11/40 fractures (27{\%}). The attending radiology CT interpretation noted the interposed structure in 8/40 fractures (20{\%}). Conclusions: In addition to the osseous injuries, CT imaging can demonstrate the posteromedial soft tissue structures. In our series, the tibialis posterior tendon was commonly incarcerated. In some cases, removal of the entrapped structure(s) may not be possible through the more commonly used anterolateral and anteromedial surgical approaches, and a separate posteromedial exposure may be required. Failure to recognize the presence of an interposed structure could lead to malreduction, impaired tendon function, neurovascular insult, and the need for further surgery.",
keywords = "entrapped structure, pilon, posteromedial",
author = "Eastman, {Jonathan Garland} and Reza Firoozabadi and Benirschke, {Stephen K.} and Barei, {David P.} and Dunbar, {Robert P.}",
year = "2014",
doi = "10.1097/BOT.0000000000000046",
language = "English (US)",
volume = "28",
pages = "528--533",
journal = "Journal of Orthopaedic Trauma",
issn = "0890-5339",
publisher = "Lippincott Williams and Wilkins",
number = "9",

}

TY - JOUR

T1 - Entrapped posteromedial structures in pilon fractures

AU - Eastman, Jonathan Garland

AU - Firoozabadi, Reza

AU - Benirschke, Stephen K.

AU - Barei, David P.

AU - Dunbar, Robert P.

PY - 2014

Y1 - 2014

N2 - Objectives: To analyze a patient cohort who sustained a tibial pilon fracture and report the incidence of interposed posteromedial soft tissue structures. Design: Retrospective cohort review. Setting: Regional Level 1 Trauma Center. Patients/Participants: About 394 patients with 420 pilon fractures treated between January 2005 and November 2011. Intervention: Each patient?s preoperative radiographs and computed tomography (CT) images were reviewed. The axial and reconstructed images were used in bone and soft tissue windows to identify any posteromedial soft tissue structures incarcerated within the fracture. Main Outcome Measurements: Medical charts reviewed for the presence of preoperative neurologic deficit, separate posteromedial incision, and whether attending radiology CT interpretation noted the interposed structure. Results: 40 patients with 40 fractures (9.5%) had an entrapped posteromedial structure. The tibialis posterior tendon was interposed in 38/40 fractures (95%) and the posterior tibial neurovascular bundle in 4/40 fractures (10%). Preoperative neurologic deficit occurred in 5/40 patients (12%). A posteromedial incision was used in 11/40 fractures (27%). The attending radiology CT interpretation noted the interposed structure in 8/40 fractures (20%). Conclusions: In addition to the osseous injuries, CT imaging can demonstrate the posteromedial soft tissue structures. In our series, the tibialis posterior tendon was commonly incarcerated. In some cases, removal of the entrapped structure(s) may not be possible through the more commonly used anterolateral and anteromedial surgical approaches, and a separate posteromedial exposure may be required. Failure to recognize the presence of an interposed structure could lead to malreduction, impaired tendon function, neurovascular insult, and the need for further surgery.

AB - Objectives: To analyze a patient cohort who sustained a tibial pilon fracture and report the incidence of interposed posteromedial soft tissue structures. Design: Retrospective cohort review. Setting: Regional Level 1 Trauma Center. Patients/Participants: About 394 patients with 420 pilon fractures treated between January 2005 and November 2011. Intervention: Each patient?s preoperative radiographs and computed tomography (CT) images were reviewed. The axial and reconstructed images were used in bone and soft tissue windows to identify any posteromedial soft tissue structures incarcerated within the fracture. Main Outcome Measurements: Medical charts reviewed for the presence of preoperative neurologic deficit, separate posteromedial incision, and whether attending radiology CT interpretation noted the interposed structure. Results: 40 patients with 40 fractures (9.5%) had an entrapped posteromedial structure. The tibialis posterior tendon was interposed in 38/40 fractures (95%) and the posterior tibial neurovascular bundle in 4/40 fractures (10%). Preoperative neurologic deficit occurred in 5/40 patients (12%). A posteromedial incision was used in 11/40 fractures (27%). The attending radiology CT interpretation noted the interposed structure in 8/40 fractures (20%). Conclusions: In addition to the osseous injuries, CT imaging can demonstrate the posteromedial soft tissue structures. In our series, the tibialis posterior tendon was commonly incarcerated. In some cases, removal of the entrapped structure(s) may not be possible through the more commonly used anterolateral and anteromedial surgical approaches, and a separate posteromedial exposure may be required. Failure to recognize the presence of an interposed structure could lead to malreduction, impaired tendon function, neurovascular insult, and the need for further surgery.

KW - entrapped structure

KW - pilon

KW - posteromedial

UR - http://www.scopus.com/inward/record.url?scp=84906933698&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84906933698&partnerID=8YFLogxK

U2 - 10.1097/BOT.0000000000000046

DO - 10.1097/BOT.0000000000000046

M3 - Article

C2 - 24343256

AN - SCOPUS:84906933698

VL - 28

SP - 528

EP - 533

JO - Journal of Orthopaedic Trauma

JF - Journal of Orthopaedic Trauma

SN - 0890-5339

IS - 9

ER -