Frame-Assisted Reduction of a B-Type Pilon Fracture Dislocation: Talar Body Incarceration on an Intact Fibula

A Case Report

Abstract

Case: 

We describe an irreducible anterolateral tibiotalar dislocation with an AO/OTA (Arbeitsgemeinschaft fur Osteosynthesefragen/Orthopaedic Trauma Association) B-type pilon fracture. The injury was initially treated with closed reduction, using a medializing force achieved with an external fixator to unhinge the talar body from the fibula, followed by temporary stabilization. Definitive fixation was performed once the soft tissues had recovered.

Conclusion: 

This unique irreducible pilon fracture dislocation pattern is important to recognize to prevent iatrogenic complications associated with multiple failed closed reduction attempts. Frame-assisted, percutaneous, or open maneuvers may be required to facilitate a reduction. Staged treatment with temporization in an external fixator may be required.