Archives of Orthopaedic and Trauma Surgery

, Volume 127, Issue 1, pp 55–60 | Cite as

Long-term results of pilon fractures

Orthopaedic Surgery



The long-term results of pilon fractures are rarely documented. The present study evaluated the long-term results related to each fracture pattern of a pilon fracture treated with open reduction and plating.


One hundred and twenty-eight pilon fractures with a mean 10-year follow-up were divided into three groups, based on the Ruedi-Allgower classification. Group A was composed of 39 patients with Ruedi-Allgower type I fractures; group B comprised 62 patients with type II fractures; and group C included 27 patients with type III fractures. The radiographs were reviewed for adequacy of fracture reduction and posttraumatic arthrosis. At the end of follow-up, the clinical results were evaluated using a rating scale.


Group C had significantly lower excellent and good reduction rates than group A or B (< 0.05). Groups B and C had progressively increased ankle arthrosis with time (= 0.043, = 0.049, respectively). Group C had more unsatisfactory clinical outcomes than group A or B (< 0.05). Operative concurrent fixation of the fractured fibula resulted in a better outcome than non-operative treatment (< 0.05). Open fractures had significantly lower satisfactory outcomes than closed fractures (60.5% versus 78.9%, P < 0.05).


Open reduction with plating was a reasonably effective procedure for the treatment of Ruedi type I pilon fractures. The long-term outcome of pilon fractures was affected by fracture patterns, fibular length restoration, quality of reduction, and severity of soft tissue injury. Posttraumatic arthrosis affecting the ankle after a severe pilon fracture (Ruedi type II or III) was a progressive disease, and required long-term follow-up.


Long-term result Pilon fracture Posttraumatic arthrosis 


  1. 1.
    Ayeni JP (1988) Pilon fractures of the tibia: a study based on 19 cases. Injury 19:109–114PubMedCrossRefGoogle Scholar
  2. 2.
    Bone LB, Stegemann P, McNamara K et al (1993) External fixation of severely comminuted and open tibial pilon fractures. Clin Orthop 292:101–107PubMedGoogle Scholar
  3. 3.
    Bourne RB (1989) Pilon fractures of the distal tibia. Clin Orthop 240:42–46PubMedGoogle Scholar
  4. 4.
    Conroy J, Agarwal M, Giannoudis PV et al (2003) Early internal fixation and soft tissue cover of severe open tibial pilon fractures. Int Orthop 27:343–347PubMedCrossRefGoogle Scholar
  5. 5.
    Dillin L, Slabaugh P (1986) Delayed wound healing, infection, and nonunion following open reduction and internal fixation of tibial plafond fractures. J Trauma 26:1116–1119PubMedGoogle Scholar
  6. 6.
    Helfet DL, Koval K, Pappas J et al (1994) Intra-articular “pilon” fracture of the tibia. Clin Orthop 298:221–228PubMedGoogle Scholar
  7. 7.
    Kellam J, Waddell JP (1979) Fractures of the distal tibial metaphysis with intra-articular extension-the distal tibial explosion fracture. J Trauma 19:593–601PubMedCrossRefGoogle Scholar
  8. 8.
    Leone VJ, Ruland RT, Meinhard BP (1993) The treatment of the soft tissue in pilon fractures. Clin Orthop 292:315–320PubMedGoogle Scholar
  9. 9.
    Leung F, Kwok HY, Pun TS et al (2004) Limited open reduction and Ilizarov external fixation in the treatment of distal tibial fractures. Injury 35:278–283PubMedCrossRefGoogle Scholar
  10. 10.
    Marsh JL, Bonar S, Nepola JV et al (1995) Use of an articular external fixator for fractures of the tibial plafond. J Bone Joint Surg Am 77:1498–1509PubMedGoogle Scholar
  11. 11.
    Marsh JL, Weigel DP, Dirschl DR (2003) Tibial plafond fractures. How do these ankles function over time? J Bone Joint Surg 85:287–295PubMedGoogle Scholar
  12. 12.
    Ovadia DN, Beals RK (1986) Fractures of the tibial plafond. J Bone Joint Surg Am 68:543–551PubMedGoogle Scholar
  13. 13.
    Patterson MJ, Cole JD (1999) Two-staged delayed open reduction and internal fixation of severe pilon fractures. J Orthop Trauma 13:85–91PubMedCrossRefGoogle Scholar
  14. 14.
    Pollak AN, McCarthy ML, Bess RS et al (2003) Outcomes after treatment of high-energy tibial plafond fractures. J Bone Joint Surg Am 85:1893–1900PubMedGoogle Scholar
  15. 15.
    Ruedi TP, Allgower M (1969) Fractures of the lower end of the tibia into the ankle joint. Injury 1:92–99CrossRefGoogle Scholar
  16. 16.
    Ruedi TP, Allgower M (1979) The operative treatment of intra-articular fractures of the lower end of the tibia. Clin Orthop 138:105–110PubMedGoogle Scholar
  17. 17.
    Saleh M, Shanahan MD, Fern ED (1993) Intra-articular fractures of the distal tibia: surgical management by limited internal fixation and articulated distraction. Injury 24:37–40PubMedCrossRefGoogle Scholar
  18. 18.
    Sirkin M, Sanders R, DiPasquale T et al (2004) A staged protocol for soft tissue management in the treatment of complex pilon fractures. J Orthop Trauma 18(8 suppl):S32–S38PubMedCrossRefGoogle Scholar
  19. 19.
    Teeny SM, Wiss DA (1993) Open reduction and internal fixation of tibial plafond fractures. Clin Orthop 292:108–117PubMedGoogle Scholar
  20. 20.
    Topliss CJ, Jackson M, Atkins RM (2005) Anatomy of pilon fractures of the distal tibia. J Bone Joint Surg Br 87:692–697PubMedCrossRefGoogle Scholar
  21. 21.
    Tornetta P 3rd, Weiner L, Bergman M et al (1993) Pilon fractures: treatment with combined internal fixation and external fixation. J Orthop Trauma 7:489–496PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  1. 1.Department of Orthopedic SurgeryChang Gung Memorial HospitalKaohsiung HsienTaiwan
  2. 2.Department of Orthopedic SurgeryTaipei City HospitalTaipeiTaiwan

Personalised recommendations