case_images: PMC10432129_01
case_images: X-rays at the time of injury (after calcaneal traction) show the tibial pilon fractures (AO/OTA 43c3.3, Ruedi-Allogoer: Type III).
case_images: CRIOR2023-9222479.001.jpg
case_images: PMC10432129_01_CRIOR2023-9222479.001.jpg
case_images: fig1
case_images: X-rays at the time of injury showed tibial pilon fractures (AO/OTA 43c3.3, Ruedi-Allgower: Type III; Figure 1).
case_images: Exterior view after fixation with an external fixator. Skin necrosis and closed fracture with soft tissue necrosis on the medial side of the lower leg (IC3-MT1-NV1).
case_images: CRIOR2023-9222479.002.jpg
case_images: PMC10432129_01_CRIOR2023-9222479.002.jpg
case_images: fig2
case_images: Soft-tissue necrosis with blisters on the medial side of the lower leg (AO soft-tissue classification: IC3-MT1-NV1) was observed (Figure 2), and the patient was referred to our hospital on day 10 of the injury.
case_images: 3D CT at the time of the injury. (a) Anterior fragments. (b) Medial fragments. (c) Posterolateral fragment.
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case_images: PMC10432129_01_CRIOR2023-9222479.003.jpg
case_images: fig3
case_images: A preoperative computed tomography (CT) examination showed that the joint surface was divided into four parts: the anterior fragment (Figures 3(a) and 4(a)), the medial bone fragment (Figures 3(b) and 4(b), the posterolateral bone fragment (Figures 3(c) and 4(c)), and the die-punch fragment (Figure 4(d)).
case_images: CT at the time of the injury. (a) Anterior fragments. (b) Medial fragments. (c) Posterolateral fragments. (d) Die-punch fragments.
case_images: CRIOR2023-9222479.004.jpg
case_images: PMC10432129_01_CRIOR2023-9222479.004.jpg
case_images: fig4
case_images: A preoperative computed tomography (CT) examination showed that the joint surface was divided into four parts: the anterior fragment (Figures 3(a) and 4(a)), the medial bone fragment (Figures 3(b) and 4(b), the posterolateral bone fragment (Figures 3(c) and 4(c)), and the die-punch fragment (Figure 4(d)).
case_images: Exterior view during surgery. (A) Restoration of the debrided articular under direct visualization. (B) After removal of the RSAF (10 cm in height and 8 cm in width with 4 cm pedicle with skin). (C) Covered area of skin loss. (a) Temporary fixation using k-wire. (b) Dissected flap.
case_images: CRIOR2023-9222479.005.jpg
case_images: PMC10432129_01_CRIOR2023-9222479.005.jpg
case_images: fig5
case_images: We removed the medial bone fragment from the debrided area and directly visualized the joint surface (Figure 5(a)), which we fixed with a cannulated cancellous screw (CCS). The flap design was enlarged from the area of the damaged defect, measuring approximately 10 cm in length and 8 cm in width (Figure 5(b)).
case_images: Post-surgery X-ray and circular external fixators. Rings were placed on the tibia at three locations, and a foot ring was placed on the foot at one location.
case_images: CRIOR2023-9222479.006.jpg
case_images: PMC10432129_01_CRIOR2023-9222479.006.jpg
case_images: fig6
case_images: Rings were placed on the tibia at three locations, and a foot ring was placed and fixed on the foot (Figure 6).
case_images: X-ray and the exterior of the RSAF one year after surgery.
case_images: CRIOR2023-9222479.007.jpg
case_images: PMC10432129_01_CRIOR2023-9222479.007.jpg
case_images: fig7
case_images: X-ray evaluation showed stage 2 arthrosis according to the Takakura ankle osteoarthritis classification (Figure 7).
case_images: X-ray 4 years after surgery. Degenerative changes were observed in the articular surface (Takakura ankle osteoarthritis classification: Stage 2).
case_images: CRIOR2023-9222479.008.jpg
case_images: PMC10432129_01_CRIOR2023-9222479.008.jpg
case_images: fig8
case_images: Stage 2 arthrosis was present according to the Takakura ankle osteoarthritis classification, but the patient was able to walk without pain (Figure 8).