Minimally Invasive Management of a Comminuted Pilon Fracture with a Multiplanar Hexapod Ring Fixator and Percutaneous ORIF

Historically, open reduction and internal fixation (ORIF) of high-energy pilon fractures has been considered the gold standard management of these challenging injuries. Nevertheless, the complication rates in terms of infection or wound dehiscence and a deeper understanding of the concomitant soft tissue injuries have created a growing interest in new minimally invasive and staged strategies of treatment (Kottmaier 2018). The use of circular external fixation with limited internal fixation has been described as an effective and safe method of treatment of pilon fractures (Swords and Weatherford, Foot Ankle Clin 25:523–36, 2020; Giannoudis et al., Strategies Trauma Limb Reconstr 16:86–95, 2021). Even though comparative studies and meta-analysis comparing both ORIF and circular fixation have not been able to recommend one treatment above the other, the use of a minimally invasive strategy can be specially useful in patients with high-risk soft tissues (Malik-Tabassum et al., Injury 51:1448–56, 2020; Erichsen et al., Eur J Orthop Surg Traumatol 29:907–17, 2019). We present a case of a high-energy open pilon fracture managed using limited percutaneous articular fixation and a multiplanar hexapod ring fixatorMultiplanar hexapod ring fixator.