Pilon Fractures of the Ankle: Fixation With a Plate and Screws Animation

Pilon Fractures of the Ankle: Fixation With a Plate and Screws Animation

In this animated video demonstration, a pilon fracture will be repaired utilizing plates and screws. An incision will be made to the front of the ankle closer to the outside of the foot. An instrument called a cobb will create a space between the bone and overlying muscles for the incoming plate. An insertion handle with the attached plate will be placed in the incision and positioned against the bone. The insertion handle will be removed.

Using the same incision, a drill and drill guide will be placed in the oblong hole to create a hole for an incoming screw. This secures the plate against the bone but also allows the plate to be repositioned as needed. Four temporary wires will secure the bottom of the plate in place. Then the drill and drill guide will be used to place a screw in one of the holes in the bottom of the plate. Once the hole is drilled, it will be measured, and a screw will be placed.

A drill guide will be used to drill a hole for a different type of screw, called a locking screw. Locking screws have threads that engage with corresponding threads in the plate, which help minimize movement of the hardware and help compress the fracture sites for optimal healing. They also prevent the plate from compressing too firmly against the bone, so blood supply can be maintained to the area. Often, locking and non-locking screws are used in combination to achieve adequate compression and stability of the fracture site.

This drill and guide allow the surgeon to measure the length of the hole to determine the screw size. The proper-sized screw is then inserted in the hole. Additional screws will be placed in the remaining holes as necessary, and the 4 wires will be removed. Moving to the top of the plate, a temporary wire has already been inserted to hold the top of the plate in place. Again, a drill guide for a locking screw will be inserted in the top hole of the plate, and as before, the hole will be drilled and measured before the appropriate screw is placed.

The temporary wire will then be removed, and additional screws will be placed as needed. A small plate may be added if additional small fractures are seen at the base of the bone near the joint. The incision will be closed, and the surgery is now complete.