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Pilon Fractures: Challenges and Solutions

Authors Saad BN, Yingling JM, Liporace FA, Yoon RS

Received 31 May 2019

Accepted for publication 28 August 2019

Published 24 September 2019 Volume 2019:11 Pages 149—157

DOI https://doi.org/10.2147/ORR.S170956

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Melinda Thomas

Peer reviewer comments 2

Editor who approved publication: Professor Clark Hung


Video abstract presented by Richard S Yoon

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Bishoy N Saad, John M Yingling, Frank A Liporace, Richard S Yoon

Division of Orthopaedic Trauma and Complex Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center - RWJBarnabas Health, Jersey City, NJ, USA

Correspondence: Richard S Yoon
Division of Orthopaedic Trauma and Complex Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center – RWJBarnabas Health, 377 Jersey Ave, Suite 280A, Jersey City, NJ 07302, USA
Tel +1 201 716 5850
Fax +1 201 915 2424
Email yoonrich@gmail.com

Abstract: Pilon fractures include a wide range of complexity. The timing and type of definitive fixation is dictated by the soft tissue injury and energy imparted to the fracture. One should have a low threshold for staged protocols and delayed definitive fixation to avoid complications. Proper radiographs and advanced imaging should be obtained for an exacting diagnosis and preoperative planning. Diligent management of the soft tissue and anatomic restoration of the articular surface, length, rotation, and axial alignment with stable fixation to the diaphysis should be obtained once feasible. Intramedullary implants with percutaneous articular fixation for simple or extra-articular patterns provide good results with little soft tissue insult in the zone of injury. Minimally invasive plate osteosynthesis techniques can help mitigate some concerns with soft tissue compromise while obtaining good articular alignment. Locking or conventional plating with lag screw fixation is used for complex articular injuries with or without fibular fixation. External fixators are generally used for temporizing measures but can be utilized as definitive fixation when indicated. There is a role for acute fusion in severely comminuted, osteoporotic, or arthritic fractures in patients with poor healing potential. This article outlines the diagnostic workup and treatment of these vexing injuries with solutions to challenges that arise.

Keywords: pilon fracture, plafond fracture, intra-articular ankle fractures, distal tibia fracture, AO/OTA 43A-C

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