External Fixation in Fracture Treatment

A 34-year-old member of the New York Fire Department (NYFD) was fighting a fire on the 4th floor of an apartment building. His fire unit was rapidly overcome by the spreading blaze and had no little choice but to jump from the building.

He landed on the pavement below and sustained multiple injuries including an atlanto-occipital dislocation, pelvic fracture and a severe distal tibial pilon fracture and associated fibula fracture. He was given a 5 percent chance of survival.

New York Presbyterian/Weill Cornell neurosurgeon, Dr. Roger Hartl, performed surgery to repair the spinal cord injury; and Orthopaedic Surgeons Dr. Helfet and Dr. Lorich addressed the pelvic fracture and the distal tibia fracture.

A spanning external fixator was placed for initial fixation with concurrent fibula ORIF including placement of a Locking Compression Plate (LCP). Open reduction and internal fixation of the pilon fracture was performed one week later through an anteromedial approach with placement of plates and screws (LCP medially and pelvic reconstruction plate anterolaterally).

After eight months of recovery in the hospital he walked out of the hospital. He has returned for regular follow-up intervals and radiographs revealed healing of his fractures. At 14 months following his injuries he presented with good results with a healed distal tibia and pelvic fracture and he has also made a good clinical recovery.

  • Figure A

    Figure A

    Anteroposterior (AP) and lateral x-rays reveal an AO/OTA Type 43-C3 distal tibia pilon fracture with extensive articular involvement; (right images) AP and lateral x-rays of the right ankle following placement of a spanning external fixator; (top images) CT scan images delineating the articular fracture lines.


  • Figure B

    Figure B

    Preoperative plan for open reduction and internal fixation (1 week following placement of a spanning external fixator and fibula plating).


  • Figure C

    Figure C

    Radiographs at 14 months following ORIF illustrating a healed pilon fracture with maintenance of joint space and fixation.


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David L. Helfet, MD 

Dean G. Lorich, MD

David S. Wellman, MD