Lower Extremity Fractures
A “pilon” fracture is a complex fracture of the end of the tibia or shin bone. This injury is very severe because it involves the ankle joint. Long term complications include infection, crooked ankles and debilitating arthritis. The most important factor in treating a pilon fracture is respecting the horrible soft tissue injuries of the skin that occur around them and attempt to get an anatomic reduction of the joint surface that has been disrupted. Years of experience by trauma surgeons around the world have shown that respecting the soft tissue is of utmost importance; therefore, if you have a pilon fracture, you will likely have at least two operations. The first will be to “span” the ankle joint with an external fixator. This keeps the bones in their original length while the bruising subsides. About ten days later the external fixator is removed and the joint itself is opened and repaired.
The tibial plateau is the upper surface of the tibia or shin bone that makes up the bottom half of the knee joint. Fractures of this joint surface are very common in high energy trauma such as auto accidents and pedestrian versus auto. Meticulous management of the skin, muscles, tendons and ligaments is crucial to the successful healing of a tibial plateau fracture. Like all fractures involving joints, plateau injuries should be managed by experienced trauma surgeons who understand the nuances of these complex injuries. Severe plateau fractures are often complicated by compartment syndrome, a condition that results in uncontrolled swelling of muscle and decreased blood flow to the leg. Compartment syndrome is a surgical emergency. Our surgeons have extensive training in the management of tibial plateau fractures. They utilize the latest techniques in minimally invasive surgery and early motion to help patients recover from these severe fractures.
Compartment syndrome is a surgical emergency that is not an uncommon occurrence in orthopedic trauma. This condition results when an extremity is crushed or injured and bleeding and swelling occurs in the muscle. Each muscle in our body is wrapped in a compartment. As the swelling increases, the pressure in the compartment rises. If the pressure exceeds the patient’s blood pressure, then blood can no longer get into the muscles and the extremity can die. Compartment syndrome can result in limb loss and even death if not treated quickly. The compartments are opened with a knife and the muscle is decompressed. The wounds are closed at a later date or they are covered with a skin graft. Compartment syndrome is most common in the leg, but also occurs in the thigh, arm, forearm and the buttock.
The calcaneus is the large spongy bone that makes the heel of your foot. Fractures of the calcaneus are rare and often devastating injuries. They occur most often when patients have a fall from a height or are in high energy car accidents. They can be associated with other lower extremity trauma and spinal injuries. A calcaneus fracture changes the shape of the back of the foot, making it difficult to wear shoes. Furthermore, severe calcaneus fractures involve an important joint in the back of the foot called the subtalar joint. The subtalar joint is very important for walking, especially on uneven surfaces.
The calcaneus is a complex bone, and surgery in this region is equally demanding. Even in the most experienced hands the complication rate is as high as 10%. Our surgeons are trained with the world’s leading expert on fractures of the calcaneus, Dr. Roy Sanders. Not all calcaneus fractures are amenable to surgery. The surgeons at SOTS will help you understand your injury and whether or not surgery is needed.