Tibial Pilon Fractures

Fractures of the distal tibia involving the weight bearing area and the adjacent metaphysis are called ‘pilon fractures’. They are mostly associated with high-energy trauma (e.g., motor vehicle accidents) and are difficult to treat. Besides the fracture pattern, the condition of the local soft tissues plays an important role for further treatment. Therefore, the authors advice a two-staged procedure (span-scan-plan) with initial application of a spanning external fixator followed by definitive fixation until the soft tissue swelling has subsided. Various approaches and implants are available and must be adapted to the fracture pattern and the local soft tissue situation. Articular reduction must be anatomical whenever feasible and fixed with absolute stability while the metaphyseal fracture zone should be stabilized (in a minimally invasive technique) with correct axis, length, and rotation. Forty-eight hours’ postoperative ambulation is started with toe-touch weight bearing (10–15 kg) using two crutches. In order to achieve the best possible result, further immobilization in a cast or brace is usually avoided so that the joint can be mobilized passively and actively with physiotherapy.