INTRAARTICULAR PILON FRACTURE OF THE TIBIA

Classification and treatment options for the management of tibial pilo n fractures are reviewed. For comminuted and/or displaced fractures th at require open reduction and internal fixation, a detailed descriptio n of the surgical technique, including indirect reduction techniques, is provided. Thirty-four pilon fractures (32 patients) treated during a period of five years (1984-1989) were reviewed. All were high-energy injuries (15 patients with multiple trauma) with Ruedi-Allgower Type II in 26 and Type III in eight. Eighteen (56%) were open fractures. Si x fractures were treated with external fixation and the remaining 28 w ith open reduction and internal fixation. The patient follow-up examin ation period averaged 16.2 months (range, six: to 38 months). Thirty ( 88%) fractures had united by 16 weeks (two delayed unions, one below k nee amputation, and one plate breakage). In the 26 Type II fractures, functional grading found 17 excellent (65%) and six (23%) poor results . In the eight Type III fractures, there were four (50%) excellent and three (37%) poor results. Complications included one superficial pin- tract infection and two deep wound infections, both in Grade II open f ractures.