![]() ![]() This method of skeletal stabilisation has superseded calcaneal traction as it permits patient mobilisation albeit non-weight bearing. An extension of the fixator onto the forefoot (usually the first metatarsal) is helpful to avoid an equinus contracture. Fixator constructs vary with ‘delta’ and ‘A’ frames assemblies being most common. A careful restoration of alignment with the external fixator must be considered at this early stage. Temporary stabilisation should be performed as soon as possible but preferably during daylight hours on a designated operating list. Although the authors reported good inter-observer reliability, their findings have yet to be replicated. This study offered an interesting insight into the spectrum of fracture pattern variability. The coronal plane fractures tended to present in valgus and were associated with lower-energy injuries in older patients. These subtypes were assessed for patient and deformity characteristics, noting that sagittal plane fractures tended to present in varus and had resulted from higher-energy injuries in younger individuals. Their study provided a CT-based classification segregating fracture patterns into two main families, which were termed ‘sagittal’ and ‘coronal’ based on the primary fracture line seen on axial cuts at the level of the plafond. It is this subgroup, which comprises true high-energy pilon fractures, where significant discrepancy and disagreement exist in the literature over management. ![]() Of these, 67 patients (52 %) had the more complex C3 injuries. reviewed a consecutive series of 126 pilon fractures with 115 cases classified as AO/OTA ‘C’ type injuries. ![]() They concluded that compartmentalising fracture severity, which behaves as a continuous and not a dichotomous variable, should be avoided. They found moderate correlation for groups A, B or C and poor correlation between subgroup detection. raised concern about classification systems in general when reporting on the inter-observer reliability of the AO/OTA system. This article focuses on the controversies in the management of high-energy pilon fractures, and we present a treatment algorithm based on the authors’ collective clinical experience. The challenge lies in minimising complications, such as deep infection, whilst optimising clinical outcome through appropriate and well-timed surgery. Microscopic articular cartilage damage that occurs at the time of injury has significant bearing on the long-term prognosis even in the presence of anatomical joint reduction. Two-stage management with initial spanning external fixation allows soft tissue resuscitation prior to definitive management and has gained acceptance by most surgeons. The treatment objectives are to restore articular congruency and mechanical alignment and to allow early functional rehabilitation whilst minimising soft tissue complications. Open fractures are common, and even in the absence of an open lesion, significant soft tissue damage must be appreciated in closed injuries. The degree of trauma to the surrounding soft tissue envelope cannot be underestimated there is limited muscle cover between the skin and bone at this level of the lower limb, and the energy of the injury is transferred directly to these soft tissue structures. These commonly result from falls from a height or from motor-vehicle-related accidents. High-energy tibial ‘pilon’ fractures are due to axial loading with the talus driven into the distal tibia, exploding the distal tibial articular surface with impaction of the comminuted metaphyseal bone, and with occasional proximal diaphyseal extensions. ![]() Etienne Destot, a French Radiologist, is credited for using the term to describe the fracture in 1911. ![]()
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