Pilon Fracture Part 1: Classification, Diagnosis & Approaches by Prof. Dr. Sherif A. Khaled

Introduction to the Lecture

Overview of the Session

• The session begins with greetings and an introduction to lecture number 39 organized by the orthopedic department in Nasr City during a quarantine period.

• The speaker emphasizes the importance of today's topic, noting that Dr. Abdel is not present, and introduces Dr. Sherif Khaled, a professor of orthopedic surgery.

• Dr. Sherif Khaled authored a chapter in the AOTROMA TEXT 2018, indicating that today's information will be high-quality and relevant for medical professionals.

Content Structure

Lecture Format

• The speaker mentions they will communicate in Arabic due to various topics being covered and their extensive experience since 2001.

• They acknowledge learning from colleagues like Zahir and Mohamed Abdel Karim through shared courses and experiences.

• The lecture aims to cover significant material within one session, focusing on classification diagnoses and treatment approaches.

Key Concepts in Fracture Management

Understanding Fractures

• The speaker discusses considerations when dealing with fractures, emphasizing understanding fracture configuration before treatment decisions.

• Classification systems are crucial as they aid in determining patient treatment plans; special attention is given to "failure patterns" which influence decision-making regarding surgical interventions.

Chapter Insights from AOTROMA TEXT

Updates on Fracture Classifications

• Dr. Khaled's chapter was revised significantly compared to previous editions; it was restructured entirely from scratch based on new insights since 2015.

• While some content remains consistent with earlier versions (2009), substantial updates reflect advancements in understanding fractures.

Fracture Configuration Details

Types of Fragments

• Discussion includes different types of fragments such as medial malleolus and posterior lateral fragments, highlighting their significance in fracture management.

• Reference is made to a study published in 2013 that categorized various bimalleolar fractures based on specific lines of fracture.

Classification Systems for Distal Tibia Fractures

New Classification Introduced

• A new classification system developed by the Orthopedic Trauma Association (OTA), which categorizes distal tibia fractures into extra-articular, partial articular, and complete articular types.

• Emphasis is placed on understanding these classifications as they directly impact treatment strategies for patients suffering from such injuries.

Complexity of Multi-fragmentary Injuries

Challenges in Treatment Approaches

• Multi-fragmentary injuries are identified as complex cases requiring careful consideration during diagnosis and treatment planning.

• The discussion concludes with an emphasis on recognizing these complexities when treating patients with severe ankle fractures or similar conditions.

Classification of Tibial Fractures

Overview of Classification Systems

• A new classification system for tibial fractures was published in 2017 by Leonat Tiyoti, focusing on CT-based classifications. It includes a prognostic aspect and is categorized into types based on fracture characteristics.

• The classification starts from Type 2, with Type 2S indicating sagittal fractures and Type 2F indicating frontal fractures. This system utilizes CT scans to categorize the fractures effectively.

Comminution Types

• Different types of comminution are identified: anterior, lateral, medial, and posterior. Understanding these types is crucial for selecting appropriate plate configurations during treatment.

• The importance of supporting the column affected by failure is emphasized when determining the type of fixation needed.

Failure Patterns in Fibula

• The concept of "failure patterns" is introduced as a critical factor in treatment decisions. These patterns help identify how the fibula may fail under stress.

• There are three forms of fibular failure: tension, compression, and intact fibula. Each form has implications for surgical intervention strategies.

Importance of Failure Patterns

• Failure patterns define the force vector acting on the fracture site and dictate necessary interventions to counteract displacement.

• Recognizing whether there’s a tendency towards displacement helps determine if additional support is required for specific columns (e.g., medial column).

Surgical Considerations

• When dealing with an intact fibula, it’s essential to assess load distribution carefully to ensure proper healing post-surgery.

• Approaches such as medial or anterolateral may be necessary depending on fracture characteristics and associated injuries.

This structured summary captures key insights from the transcript while providing timestamps for easy reference back to specific discussions within the video content.