Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jun 16;6(3 Suppl):e236.
doi: 10.1097/OI9.0000000000000236. eCollection 2023 Jun.

Pilon fractures: Consensus and controversy

Michael Flores  1 , Matthew Ciminero  1 , Stephen A Kottmeier  2 , Daniel Botros  2 , Boris A Zelle  3 , David W Shearer  1
Affiliations

Pilon fractures: Consensus and controversy

Michael Flores et al. OTA Int. .

Abstract

Pilon fractures are complex injuries that require an individualized approach to treatment to avoid complications and achieve good outcomes. Staged open reduction internal fixation remains the gold standard for most cases to achieve anatomic articular reduction while minimizing soft tissue complications and infection. Careful preoperative planning based on computed tomography dictates the surgical approach for reduction. A subset of cases may be amenable to early definitive or provisional open reduction and internal fixation based on fracture pattern. In some cases of severe articular comminution where reconstruction is not possible, primary ankle arthrodesis may be a good alternative.

Keywords: ankle fracture; pilon fracture; tibial plafond.

PubMed Disclaimer

Figures

FIGURE 1.
FIGURE 1.
Provisional fixation with a delta frame external fixator. Two pins are placed proximally in the tibia. A centrally threaded transfixion pin is placed in the calcaneus to form the “delta.” A fourth pin is placed in the midfoot across the cuneiforms to maintain a plantigrade foot.
FIGURE 2.
FIGURE 2.
Pilon fracture fragments and ligaments. Pilon fragments include the medial malleolus (M), anterolateral (AL), and posterolateral (PL) fragments. Ligaments include the anterior inferior tibiofibular ligament (AITFL), the distal posterior inferior tibiofibular ligament (PITFL), and deltoid ligament. Central compaction (C) and the fibula (F) are also shown.
FIGURE 3.
FIGURE 3.
Anterior approaches to pilon fracture definitive fixation. The anteromedial (A) and anterolateral (B) are shown. For video demonstrations of these approaches, please visit https://www.youtube.com/c/IGOTPortal/videos.
FIGURE 4.
FIGURE 4.
Posterolateral approach to pilon fracture definitive fixation. The posterolateral approach with visualization of the tibia and fibula. For video demonstrations of these approaches, please visit https://www.youtube.com/c/IGOTPortal/videos.
See this image and copyright information in PMC

References

    1. Watson JT, Moed BR, Karges DE, et al. Pilon fractures: treatment protocol based on severity of soft tissue injury. Clin Orthop Relat Res. 2000;375:78–90. - PubMed
    1. Rüedi TP, Allgöwer M. Fractures of the lower end of the tibia into the ankle-joint. Injury . 1969;1:92–99.
    1. McFerran MA, Smith SW, Boulas HJ, et al. Complications encountered in the treatment of pilon fractures. J Orthop Trauma . 1992;6:195–200. - PubMed
    1. Teeny SM, Wiss DA. Open reduction and internal fixation of tibial plafond fractures. Variables contributing to poor results and complications. Clin Orthop Relat Res. 1993;292:108–117. - PubMed
    1. Sirkin M, Sanders R, DiPasquale T, et al. A staged protocol for soft tissue management in the treatment of complex pilon fractures. J Orthop Trauma . 1999;13:78–84. - PubMed