Pilon fractures of the distal tibia.

Pilon fractures are relatively rare fractures of the distal metaphysis of the tibia resulting from axial and/or rotational forces. They involve varying degrees of metaphyseal disruption, articular damage, and malleolar displacement. When severe, these injuries represent a tremendous challenge to the orthopaedic trauma surgeon. Traditional treatment of high-grade pilon fractures by closed means has led to unsatisfactory results. Open reduction and internal fixation in accordance with AO/ASIF principles has greatly improved the outcome in these often disabling fractures. Surgical technique involves anatomic restoration of fibular length, reconstruction of the plafond, bond grafting of the metaphyseal defect, and buttress plating of the medial tibia. Thorough preoperative planning and meticulous surgical technique produce predictably good results in the majority of cases.