Tibial pilon fractures

Compression fractures of the distal end of the tibia - 'pilon fractures' - are one of the most serious injuries of the lower extremity. This kind of fracture can be caused by compression as well as by direct or indirect traumatic forces, e.g. shearing, bending or torsion. The AO comprehensive ABC classification of fractures describes the fracture very well, which is important for treatment and prognosis. The first issue in the treatment of pilon fractures is the decision-making and timing of surgery. The second task is the proper fixation technique. Especially in comminuted fractures with soft-tissue damage - closed or open, which are the real problem cases - the treatment should be performed in three steps: (1) reduction and fixation of the fibula; (2) reconstruction of the tibial joint surface; (3) application of a medial or/and anterior fixator, e.g. with small pins or wires (hybrid type) or a percutaneously introduced buttress bridging plate, perhaps as a second stage, as well as a bone graft, if necessary. In the worst cases, a joint overbridging external fixator might be necessary and, only under reliable soft-tissue conditions, the classic open reduction and stabilization with a medial or anterior buttress plate is performed. The goal is the same as in other fracture treatment - ORIF and early functional treatment.