Surgical options include the following: Bridging external fixation, external fixation with limited internal fixation, nonspanning external fixation ± limited internal fixation, and staged open reduction and internal fixation.Ĭomplications following surgical management of pilon fractures, particularly wound breakdown, were historically common. Surgical timing and type of fixation utilized is largely dictated by the condition of the soft tissues. Pilon fractures treated with a cast have led to poorer outcomes than those managed operatively.
Indications for closed reduction and cast treatment of pilon fractures are limited. Understanding the soft tissue injury accompanying pilon fractures is of utmost importance for providing optimal treatment while minimizing complications. Initial management of pilon fractures depends as much on the soft tissue as the bony injury. The pilon fracture usually has an anterolateral (Chaput) fragment and a posterolateral (Volkmann) fragment.įragments usually remain attached to the distal fibula segment by the anterior and posterior tibiofibular ligaments. Pilon fractures can occur from both low- and high-energy mechanisms. The tibial pilon fracture is a rare, yet devastating injury.ĭespite the best treatment, patients sustaining high-energy pilon fractures generally do not return to their previous state of general health or function.Īfter recovery from pilon fractures, many patients continue to have debilitating pain and ankle stiffness.
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