![]() ![]() Most commonly the high–energy traumas are due to falls or jumps from great heights or motor vehicle accidents. Sometimes rather low-energy rotational forces, for example in skiing accidents, can also lead to pilon fractures, but the comminution seen in these fractures is usually less severe ( 5). In contrast to simple ankle fractures, pilon fractures usually result from high-energy trauma with heavy axial force, which basically causes the tibial plafond to burst over the talus ( 7). Furthermore, in recent studies it has been suggested that tibial pilon fractures are likely to be less comminuted and less severe when the fibula remains intact ( 6). Tibial pilon fractures with the fibula intact are more likely in AO Type B fractures than in Type C fractures. In ~75–90% of all cases the fibula is also fractured ( 5). Men tend to suffer from these injuries slightly more often than women with the majority of injuries occurring at around 45 years ( 3, 4). Tibial pilon fractures are quite rare, accounting for ~3–10% of all tibial fractures and <1% of all fractures to the lower extremity ( 1– 3). The aim of this review is therefore to summarize protocols in managing these difficult fractures, review the literature on recent developments and therefore give surgeons a better understanding and ability to handle tibial pilon fractures. Additional methods of treating the soft tissue envelope are currently being investigated and have shown promising results for the future. In the early years of this century treatment has evolved to a two–staged protocol, which nowadays is the gold standard of care. Therefore, long -term outcome is often poor and correct initial management crucial. Especially Type C fractures are extremely difficult to manage as the high energy involved in developing this type of injury frequently damages the soft tissue surrounding the fracture zone severely. Many different classification systems exist so far, with the AO Classification being the most commonly used classification in the clinical setting. This term has further been used to portray the mechanism involved in tibial pilon fractures in which the distal tibia acts as a pestle with heavy axial forces over the talus basically causing the tibia to burst. He used the French word “pilon” (i.e., pestle), to describe the mechanical function of the distal tibia in the ankle joint. Tibial pilon fractures were first described by Étienne Destot in 1911. 3Department of Trauma Surgery, Center for Musculoskeletal Surgery, Charité University Medicine Berlin, Berlin, Germany.2Center for Orthopedic and Trauma Surgery, University Medical Center, Cologne, Germany. ![]() 1Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.Braun 1,3, Chlodwig Kirchhoff 1, Peter Biberthaler 1 and Moritz Crönlein 1 Published by Elsevier Ltd.Olivia Mair 1 *, Patrick Pflüger 1, Kai Hoffeld 1,2, Karl F. The short-term complication rate was low.Īnkle fracture Fibular fracture Posterior malleolar fracture Posterior pilon fracture Posteromedial approach Syndesmotic injury.Ĭopyright © 2019. Albeit obtaining posterior malleolar fracture rigid fixation, syndesmotic instability was more prevalent than expected. Most fractures can be satisfactorily treated through a modified posteromedial approach. Posterior pilon variant fracture appears to be less common than previously reported. We report 2/25 (8%) patients with early wound problems and 7/25 (20%) with short-term complications during follow-up. Quality of reduction was assessed under CT scan in 19 patients, with 15/19 (78.9%) having anatomic reduction. Persistent syndesmotic instability was present in 11/25 (44%) patients after posterior malleolar stabilization. A modified posteromedial approach was used in 18/25 (72%) patients. The average age of patients was 42 years (22-62) 19/25 (76%) were female, and 6/25 (24%) were male. Twenty-five patients sustained a posterior pilon fracture, accounting for 13.4% of all operatively treated ankle fractures with median follow-up of 21.7 months. Parameters measured included age, sex, type of fracture, surgical technique, anatomical reduction, and complications. Posterior pilon fracture open reduction and internal fixation. Twenty-five patients with posterior pilon fracture. To review a case series of patients with posterior pilon variant fracture using a novel approach, focusing on demographic data, injury pattern, surgical results based on computed tomography (CT) scan, and short-term complications. ![]()
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