Inducing pilon fractures in human cadaveric specimens depending on the injury mechanism: a fracture simulation

Ott, N., Harbrecht, A., Hackl, M., Leschinger, T., Knifka, J., Mueller, L. P. and Wegmann, K. . Inducing pilon fractures in human cadaveric specimens depending on the injury mechanism: a fracture simulation. Arch. Orthop. Trauma Surg.. NEW YORK: SPRINGER. ISSN 1434-3916

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DOI:10.1007/s00402-020-03538-9

Abstract

Background Operative management of pilon fractures, especially high-energy compression injuries, is a challenge. Operative education is of vital importance to handle these entities. Not rarely, it is cut by economics and staff shortage. As public awareness toward operative competence rises, surgical cadaver courses that provide pre-fractured specimens can improve realism of teaching scenarios. The aim of this study is to introduce a realistic pilon fracture simulation setup regarding the injury mechanism. Materials and methods 8 cadaveric specimens (two left, six right) were fixed onto a custom drop-test bench in dorsiflexion (20 degrees) and light supination (10 degrees). The proximal part of the lower leg was potted, and the specimen was exposed to a high energetic impulse via an axial impactor. CT imaging was performed after fracture simulation to detect the exact fracture patterns and to classify the achieved fractures by two independent trauma surgeons. (AO/OTA recommendations and the Ruedi/Allgower). Results All cadaveric specimens could be successfully fractured: 6 (75%) were identified as a 43-C fracture and 2 (25%) as 43-B fracture type. Regardless of the identical mechanism two different kinds of fracture types were reported. In five cases (62.5%), the fibula was also fractured and in three specimens, a talus fracture was described. There was no statistically significant correlation found regarding Hounsfield Units (HU) and age as well as HU and required kinetic energy. Conclusion A high energetic axial impulse on a fixed ankle specimen in light dorsiflexion (20 degrees) and supination (10 degrees) induced by a custom-made drop-test bench can successfully simulate realistic pilon fractures in cadaveric specimens with intact soft tissue envelope. Although six out of eight fractures (75%) were classified as a 43-C fracture and despite putting a lot of effort into the mechanical setup, we could not achieve an absolute level of precision. Therefore, we suggest that the injury mechanism is most likely a combination of axial loading, shear and rotation.

Item Type:

Journal Article

Creators:

Creators	Email	ORCID	ORCID Put Code
Ott, N.	UNSPECIFIED	UNSPECIFIED	UNSPECIFIED
Harbrecht, A.	UNSPECIFIED	UNSPECIFIED	UNSPECIFIED
Hackl, M.	UNSPECIFIED	UNSPECIFIED	UNSPECIFIED
Leschinger, T.	UNSPECIFIED	UNSPECIFIED	UNSPECIFIED
Knifka, J.	UNSPECIFIED	UNSPECIFIED	UNSPECIFIED
Mueller, L. P.	UNSPECIFIED	UNSPECIFIED	UNSPECIFIED
Wegmann, K.	UNSPECIFIED	UNSPECIFIED	UNSPECIFIED