Closed reduction of Pilon fractures using an ankle distractor to allow for minimally invasive fixation

TECHNIQUE An open Hasson entry in the left hypochondrium, at least 5cm lateral to the defect edge, and two 5mm trocars in the subxiphoid area and left iliac fossa serve to take down hernia sac adhesions and completely expose the abdominal wall defect. Another 10mm trocar is inserted in the midline just cephalad (or caudal) to the defect to receive the camera, together with a 5mm access in the right flank (Fig 1). Cholecystectomy is then performed in the standard French fashion, taking special care to avoid accidental perforation. The gallbladder is retrieved in a bag, through the open entry, to prevent accidental spillage. A double-layer intraperitoneal mesh is placed to cover the defect and the midline trocar site with an adequate overlap and fixation.