An update on the management of high-energy pilon fractures.

High energy pilon fractures present a unique challenge to the patient and orthopaedic surgeon. Care for the soft tissue envelope is as important as management of this articular fracture. This article reviews the fundamental principles for treatment of the patient with severe pilon fracture. Staged operative care is emphasised to prevent wound and infectious complications which have historically plagued pilon fracture surgery. New innovations directed at improving results are discussed including biological planting and wound care using the vacuum assisted closure device. Lastly, validated outcomes are presented which highlight the severity of these injuries despite optimal care.