Strategies in Trauma and Limb Reconstruction

Register      Login

VOLUME 10 , ISSUE 3 ( November, 2015 ) > List of Articles


Management of high-energy tibial pilon fractures

Nebu Jacob, Amit Amin, Alex J. Trompeter

Keywords : Pilon fractures, Management, Strategy, Algorithm, Reconstruction, Bone defects

Citation Information : Jacob N, Amin A, Trompeter AJ. Management of high-energy tibial pilon fractures. 2015; 10 (3):137-147.

DOI: 10.1007/s11751-015-0231-5

License: CC BY-NC-SA 4.0

Published Online: 01-12-2013

Copyright Statement:  Copyright © 2015; The Author(s).


Tibial pilon fractures result from high-energy trauma unlike usual ankle fractures. Their management provides numerous challenges to the orthopaedic surgeon including obtaining anatomic reduction of articular surface and the management of associated soft tissue injuries. This article aims to review major advances and principles that guide our practice today. We also discuss a treatment algorithm based on a staged approach to the fracture: initial spanning external fixation followed by definitive fixation.

PDF Share
  1. Helfet DL, Koval K, Pappas J, Sanders RW, DiPasquale T (1994) Intraarticular “pilon” fracture of the tibia. Clin Orthop Relat Res 298:221-228
  2. Tarkin I, Clare M, Marcantonio A, Pape H (2008) An update on the management of high-energy pilon fractures. Injury 39(2):142-154
  3. Sirkin M, Sanders R, DiPasquale T, Herscovici D Jr (1999) A staged protocol for soft tissue management in the treatment of complex pilon fractures. J Orthop Trauma 13(2):78-84
  4. Höntzsch D, Karnatz N, Jansen T (1990) One-or two-step management (with external fixator) of severe pilon-tibial fractures. Aktuelle Traumatol 20(4):199-204
  5. Patterson MJ, Cole JD (1999) Two-staged delayed open reduction and internal fixation of severe pilon fractures. J Orthop Trauma 13(2):85-91
  6. Rommens P, Claes P, Broos P (1996) Therapeutic strategy in pilon fractures type C2 and C3: soft tissue damage changes treatment protocol. Acta Chir Belg 96(2):85-92
  7. Tornetta P III, Weiner L, Bergman M, Watnik N, Steuer J, Kelley M, Yang E (1993) Pilon fractures: treatment with combined internal and external fixation. J Orthop Trauma 7(6):489-496
  8. Furman BD, Olson SA, Guilak F (2006) The development of posttraumatic arthritis after articular fracture. J Orthop Trauma 20(10):719-725
  9. Borrelli J Jr, Ricci WM (2004) Acute effects of cartilage impact. Clin Orthop Relat Res 423:33-39
  10. Rüedi TP, Allgöwer M (1979) The operative treatment of intraarticular fractures of the lower end of the tibia. Clin Orthop Relat Res 138:105-110
  11. Marsh J, Slongo TF, Agel J, Broderick JS, Creevey W, DeCoster TA, Prokuski L, Sirkin MS, Ziran B, Henley B (2007) Fracture and dislocation classification compendium-2007: Orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma 21(10):S1-S6
  12. Swiontkowski M, Sands A, Agel J, Diab M, Schwappach J, Kreder H (1997) Interobserver variation in the AO/OTA fracture classification system for pilon fractures: is there a problem? J Orthop Trauma 11(7):467-470
  13. Topliss C, Jackson M, Atkins R (2005) Anatomy of pilon fractures of the distal tibia. J Bone Joint Surg Br 87(5):692-697
  14. Tornetta P III, Gorup J (1996) Axial computed tomography of pilon fractures. Clin Orthop Relat Res 323:273-276
  15. McFerran MA, Smith SW, Boulas HJ, Schwartz HS (1992) Complications encountered in the treatment of pilon fractures. J Orthop Trauma 6(2):195-200
  16. Lee Y-S, Chen S-W, Chen S-H, Chen W-C, Lau M-J, Hsu T-L (2009) Stabilisation of the fractured fibula plays an important role in the treatment of pilon fractures: a retrospective comparison of fibular fixation methods. Int Orthop 33(3):695-699
  17. Rouhani A, Elmi A, Akbari Aghdam H, Panahi F, Dokht Ghafari Y (2012) The role of fibular fixation in the treatment of tibia diaphysis distal third fractures. Orthop Traumatol Surg Res 98(8):868-872
  18. Williams TM, Marsh JL, Nepola JV, DeCoster TA, Hurwitz SR, Bonar SB (1998) External fixation of tibial plafond fractures: is routine plating of the fibula necessary? J Orthop Trauma 12(1):16-20
  19. Assal M, Ray A, Stern R (2007) The extensile approach for the operative treatment of high-energy pilon fractures: surgical technique and soft-tissue healing. J Orthop Trauma 21(3):198-206
  20. Borens O, Kloen P, Richmond J, Roederer G, Levine DS, Helfet DL (2009) Minimally invasive treatment of pilon fractures with a low profile plate: preliminary results in 17 cases. Arch Orthop Trauma Surg 129(5):649-659
  21. Blauth M, Bastian L, Krettek C, Knop C, Evans S (2001) Surgical options for the treatment of severe tibial pilon fractures: a study of three techniques. J Orthop Trauma 15(3):153-160
  22. Walker C, Garg A, McQueen M (1999) Half-ring external fixation in the management of tibial plafond fractures. J Orthop Trauma 13(3):200-206
  23. Barbieri R, Schenk R, Koval K, Aurori K, Aurori B (1996) Hybrid external fixation in the treatment of tibial plafond fractures. Clin Orthop Relat Res 332:16-22
  24. Marsh JL, Bonar S, Nepola JV, Decoster TA, Hurwitz SR (1995) Use of an articulated external fixator for fractures of the tibial plafond. J Bone Joint Surg Am 77(10):1498-1509
  25. Anglen JO (1999) Early outcome of hybrid external fixation for fracture of the distal tibia. J Orthop Trauma 13(2):92-97
  26. Davies R, Holt N, Nayagam S (2005) The care of pin sites with external fixation. J Bone Joint Surg Br 87(5):716-719
  27. Papadokostakis G, Kontakis G, Giannoudis P, Hadjipavlou A (2008) External fixation devices in the treatment of fractures of the tibial plafond: a systematic review of the literature. J Bone Joint Surg Br 90(1):1-6
  28. McDonald MG, Burgess RC, Bolano LE, Nicholls PJ (1996) Ilizarov treatment of pilon fractures. Clin Orthop Relat Res 325:232-238
  29. Leung F, Kwok HY, Pun TS, Chow SP (2004) Limited open reduction and Ilizarov external fixation in the treatment of distal tibial fractures. Injury 35(3):278-283
  30. Vidyadhara S, Rao SK (2006) Ilizarov treatment of complex tibial pilon fractures. Int Orthop 30(2):113-117
  31. Watson JT, Moed BR, Karges DE, Cramer KE (2000) Pilon fractures: treatment protocol based on severity of soft tissue injury. Clin Orthop Relat Res 375:78-90
  32. Wang D, Xiang J-P, Chen X-H, Zhu Q-T (2015) A meta-analysis for postoperative complications in tibial plafond fracture: open reduction and internal fixation versus limited internal fixation combined with external fixator. J Foot Ankle Surg 54(4):646-651. doi:10.1053/j.jfas.2014.06.007
  33. Johnson EE, Urist MR, Am Finerman G (1992) Resistant nonunions and partial or complete segmental defects of long bones: treatment with implants of a composite of human bone morphogenetic protein (BMP) and autolyzed, antigen-extracted, allogeneic (AAA) bone. Clin Orthop Relat Res 277:229-237
  34. Pelissier P, Masquelet A, Bareille R, Pelissier SM, Amedee J (2004) Induced membranes secrete growth factors including vascular and osteoinductive factors and could stimulate bone regeneration. J Orthop Res 22(1):73-79
  35. Hertel R, Pisan M, Jakob R (1995) Use of the ipsilateral vascularised fibula for tibial reconstruction. J Bone Joint Surg Br 77(6):914-919
  36. DeCoster TA, Gehlert RJ, Mikola EA, Pirela-Cruz MA (2004) Management of posttraumatic segmental bone defects. J Am Acad Orthop Surg 12(1):28-38
  37. Simpson A, Andrews C, Giele H (2001) Skin closure after acute shortening. J Bone Joint Surg Br 83(5):668-671
  38. Ilizarov GA (1989) The tension-stress effect on the genesis and growth of tissues—part I: the influence of stability of fixation and soft-tissue preservation. Clin Orthop Relat Res 238:249-281
  39. Ilizarov GA (1989) The tension-stress effect on the genesis and growth of tissues—part II: the influence of the rate and frequency of distraction. Clin Orthop Relat Res 239:263-285
  40. Dagher F, Roukoz S (1991) Compound tibial fractures with bone loss treated by the Ilizarov technique. J Bone Joint Surg Br 73(2):316-321
  41. Saleh M, Rees A (1995) Bifocal surgery for deformity and bone loss after lower-limb fractures: comparison of bone-transport and compression-distraction methods. J Bone Joint Surg Br 77(3): 429-434
  42. Keating J, Simpson A, Robinson C (2005) The management of fractures with bone loss. J Bone Joint Surg Br 87(2):142-150
  43. Conroy J, Agarwal M, Giannoudis P, Matthews S (2003) Early internal fixation and soft tissue cover of severe open tibial pilon fractures. Int Orthop 27(6):343-347
  44. Gardner MJ, Mehta S, Barei DP, Nork SE (2008) Treatment protocol for open AO/OTA type C3 pilon fractures with segmental bone loss. J Orthop Trauma 22(7):451-457
  45. Pollak AN, McCarthy ML, Bess RS, Agel J, Swiontkowski MF (2003) Outcomes after treatment of high-energy tibial plafond fractures. J Bone Joint Surg 85(10):1893-1900
  46. Teeny SM, Wrss DA (1993) Open reduction and internal fixation of tibial plafond fractures: variables contributing to poor results and complications. Clin Orthop Relat Res 292:108-117
  47. Okcu G, Aktuglu K (2004) Intra-articular fractures of the tibial plafond: a comparison of the results using articulated and ring external fixators. J Bone Joint Surg Br 86(6):868-875
  48. Sands A, Grujic L, Byck DC, Agel J, Benirschke S, Swiontkowski MF (1998) Clinical and functional outcomes of internal fixation of displaced pilon fractures. Clin Orthop Relat Res 347:131-137
  49. Chen S-H, Wu P-H, Lee Y-S (2007) Long-term results of pilon fractures. Arch Orthop Trauma Surg 127(1):55-60
  50. Marsh JL, Weigel DP, Dirschl DR (2003) Tibial plafond fractures how do these ankles function over time? J Bone Joint Surg 85(2):287-295
  51. Calori G, Tagliabue L, Mazza E, de Bellis U, Pierannunzii L, Marelli B, Colombo M, Albisetti W (2010) Tibial pilon fractures: which method of treatment? Injury 41(11):1183-1190
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.