Pilon fractures are complex intra-articular injuries of the distal tibial plafond where the soft tissue envelope dictates absolutely all timing decisions. Master the staged management of these high-energy injuries using the Span, Scan, Plan protocol to minimise wound complications and optimise articular reduction. ⏱ Chapters 0:00 Intro 0:19 Essentials 0:48 Classification 1:06 Ao 1:29 Span 1:53 Columns 2:14 Imaging 2:40 Algorithm 3:09 Fixation 3:36 Numbers 3:57 Clinical reasoning — Soft 4:24 Clinical reasoning — Pilon This comprehensive masterclass covers the diagnosis, classificationand definitive management of tibial plafond fractures. We explore the Ruedi-Allgower and AO/OTA classification systems, the three-column articular mapping conceptand the critical staged surgical protocol required to safely navigate the anteromedial watershed zone. From initial spanning external fixation through to definitive ORIF, you will learn the precise surgical approaches and fixation strategies necessary to manage these notoriously unforgiving orthopaedic injuries. 🦴 IN THIS VIDEO YOU'LL LEARN • How to classify pilon fractures using the Ruedi-Allgower and AO/OTA (43-C) systems • The importance of the anteromedial soft tissue envelope and how it dictates surgical timing • Applying the Span, Scan, Plan philosophy for staged orthopaedic management • Interpreting CT scans using the MAP framework of anteromedial, anterolateraland posterior columns • Identifying key anatomical fracture fragments including the Tillaux-Chaput and Volkmann fragments • The criteria for proceeding to definitive fixation, including the wrinkle sign and fracture blister management • Choosing the correct surgical approach based on the articular column requiring reconstruction • Understanding the back-to-front and lateral-to-medial sequence for articular block reconstruction • Managing severe open pilon fractures (Grade IIIB) and knowing when to consider primary arthrodesis ⏱️ CHAPTERS 📌 KEY TAKEAWAYS ✔️ Soft tissue is king: never plate through swollen or blistered skin ✔️ Syndesmosis is often intact in pilon fractures because the primary mechanism is axial loading, not rotation ✔️ A minimum 7cm skin bridge must be maintained between surgical incisions ✔️ Haemorrhagic blisters must be left intact until epithelialisation, while clear blisters can be incised carefully ✔️ Over 50% of patients develop post-traumatic arthritis, directly correlating with the quality of articular reduction 👩⚕️ WHO THIS IS FOR This masterclass is designed for orthopaedic trainees, junior doctorsand medical students seeking a deep understanding of lower limb trauma. Clinicians managing acute orthopaedic presentations and curious patients looking for detailed, high-level information on distal tibial injuries will also find it highly valuable. 📚 RELATED TOPICS: Rotational Ankle Fractures and Syndesmotic Injury · Tibial Plateau Fractures: Principles of Bicondylar Reconstruction · External Fixation Principles in Orthopaedic Trauma · Compartment Syndrome of the Leg and Foot · Post-Traumatic Osteoarthritis of the Ankle 🔗 More free orthopaedic teaching at Orthovellum.com — subscribe for weekly videos. 🎨 CREDITS • Original Orthovellum production. ⚠️ DISCLAIMER: Educational only — not individual medical advice. Always consult a qualified clinician for diagnosis and treatment. #orthopaedics #pilonfracture #orthopaedicsurgery #traumasurgery #anklefracture #orthopedics #tibialplafond #fracturefixation #orif #bonesurgery #medicaleducation #orthopedictrauma