Tibial Pilon Fractures

  • Walter Daghino
  • Alessandro Massè
  • Daniele Marcolli


Tibial plafond fractures affect the distal meta-epiphyseal tibia associated with an important cartilage involvement. Classification, treatment and indications and surgical timing are milestones in the two-step treatment that is the gold standard for these lesions. The goals of the surgery and the surgical technique for both temporary fixation and definitive treatment techniques are the main topics that need a careful consideration.


  1. 1.
    Destot E (1937) Traumatisme du pied et rayons X. Masson, ParisGoogle Scholar
  2. 2.
    Sanders RW, Walling AK (2007) Pilon fractures. In: Coughlin MJ, Mann RA, Saltzman CL (eds) Surgery of the foot and ankle, 8th edn. Mosby Elsevier, Philadelphia, pp 1941–1971Google Scholar
  3. 3.
    Koulouvaris P, Stafylas K, Mitsionis G et al (2007) Long-term results of various therapy concepts in severe pilon fractures. Arch Orthop Trauma Surg 127(5):313–320CrossRefPubMedGoogle Scholar
  4. 4.
    Tarkin IS, Clare MP, Marcantonio A et al (2008) An update on the management of high-energy pilon fractures. Injury 39(2):142–154CrossRefPubMedGoogle Scholar
  5. 5.
    Muller ME, Nazarian S, Koch P (1990) AO classification of fractures. Springer, BerlinGoogle Scholar
  6. 6.
    Kellam JF, Waddell JP (1979) Fractures of the distal tibial metaphysic with intra-articular extension- the distal tibial explosion fracture. J Trauma 19(8):593–601CrossRefPubMedGoogle Scholar
  7. 7.
    Ruedi T, Matter P, Allgower M (1968) Intra-articular fractures of the distal tibial end. Helv Chir Acta 35(5):556–582PubMedGoogle Scholar
  8. 8.
    Orthopaedic Trauma Association Committee for coding and Classification (1996) Fracture and dislocation compendium. J Orthop Trauma 10(Suppl 1):v–ix, 1-154Google Scholar
  9. 9.
    Anderson DD, Chubinskaya S, Guilak F et al (2011) Post-traumatic osteoarthritis: improved understanding and opportunities for early intervention. J Orthop Res 29(6):802–809CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Barei DP, Nork SE (2008) Fractures of the tibial plafond. Foot Ankle Clin 13(4):571–591CrossRefPubMedGoogle Scholar
  11. 11.
    Buckwalter JA (1995) Activity vs. rest in the treatment of bone, soft tissue and joint injuries. Iowa Orthop J 15:29–42PubMedCentralPubMedGoogle Scholar
  12. 12.
    Mitchell N, Shepard N (1980) Healing of articular cartilage in intrarticular fractures in rabbits. J Bone Joint Surg Am 62A(4):628–634CrossRefGoogle Scholar
  13. 13.
    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):S32–S38CrossRefPubMedGoogle Scholar
  14. 14.
    Sommer C, Baumgaertner MR (2007) Tibia, distal intraarticular (pilon). In: Ruedi TP, Buckley RE, Moran CG (eds) AO principles of fracture management, 2nd expanded edn. Thieme, New York, pp 855–869Google Scholar
  15. 15.
    Shatzer J, Tile M (1987) The rationale for operative fracture care, 1st edn. Springer, New YorkGoogle Scholar
  16. 16.
    Joshi D, Singh D, Ansari J et al (2006) Immediate open reduction and internal fixation in open ankle fractures. J Am Podiatr Med Assoc 96(2):120–124CrossRefPubMedGoogle Scholar
  17. 17.
    Zalavras CG, Patzakis MJ, Holtom PD et al (2005) Management of open fractures. Infect Dis Clin N Am 19(4):915–929CrossRefGoogle Scholar
  18. 18.
    Hulsker CC, Kleinveld S, Zonnenberg CB et al (2011) Evidence-based treatment of open ankle fractures. Arch Orthop Trauma Surg 131(11):1545–1553CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Bray TJ, Endicott M, Capra SE (1989) Treatment of open ankle fractures. Immediate internal fixation versus closed immobilization and delayed fixation. Clin Orthop Relat Res 240:47–52Google Scholar
  20. 20.
    Bhandari M, Schemitsch EH, Adili A et al (1999) High and low pressure pulsatile lavage of contaminated tibial fractures: an in vitro study of bacterial adherence and bone damage. J Orthop Trauma 13(8):526–533CrossRefPubMedGoogle Scholar
  21. 21.
    Hassinger SM, Harding G, Wongworawat MD (2005) High-pressure pulsatile lavage propagates bacteria into soft tissue. Clin Orthop Relat Res 439:27–31CrossRefPubMedGoogle Scholar
  22. 22.
    Tarkin IS, Sop A, Pape HC (2008) High-energy foot and ankle trauma: principles for formulating an individualized care plan. Foot Ankle Clin N Am 13:705–723CrossRefGoogle Scholar
  23. 23.
    Blauth M, Bastian L, Krettek C et al (2001) Surgical options for the treatment of severe tibial pilon fractures: a study of three techniques. J Orthop Trauma 15(3):153–160CrossRefPubMedGoogle Scholar
  24. 24.
    Egol KA, Wolinsky P, Koval KJ (2000) Open reduction and internal fixation of tibial pilon fractures. Foot Ankle Clin 5(4):873–885PubMedGoogle Scholar
  25. 25.
    Dickson KF, Montgomery S, Field J (2001) High energy plafond fractures treated by a spanning external fixator initially and followed by a second stage open reduction internal fixation of the articular surface-preliminary report. Injury 32(Suppl 4):SD92–SD98CrossRefPubMedGoogle Scholar
  26. 26.
    Bacon S, Smith WR, Morgan SJ et al (2008) A retrospective analysis of comminuted intra-articular fractures of the tibial plafond: open reduction and internal fixation versus external Ilizarov fixation. Injury 39(2):196–202CrossRefPubMedGoogle Scholar
  27. 27.
    Boraiah S, Kemp TJ, Erwteman A et al (2010) Outcome following open reduction and internal fixation of open pilon fractures. J Bone Joint Surg Am 92A(2):346–352CrossRefGoogle Scholar
  28. 28.
    Ketz J, Sanders R (2012) Staged posterior tibial plating for the treatment of Orthopaedic Trauma Association 43C2 and 43C3 tibial pilon fractures. J Orthop Trauma 26(6):341–347CrossRefPubMedGoogle Scholar
  29. 29.
    Sirkin M, Sanders R, DiPasquale T et al (1999) A staged protocol for soft tissue management in the treatment of complex pilon fractures. J Orthop Trauma 13(2):78–84CrossRefPubMedGoogle Scholar
  30. 30.
    Cierny G 3rd, Byrd HS, Jones RE (1983) Primary versus delayed soft tissue coverage for severe open tibial fractures. A comparison of results. Clin Orthop Relat Res 178:54–63Google Scholar
  31. 31.
    Lavini F, Dall’Oca C, Mezzari S et al (2014) Temporary bridging external fixation in distal tibial fracture. Injury 45:S58–S63CrossRefPubMedGoogle Scholar
  32. 32.
    He X, Hu Y, Ye P et al (2013) The operative treatment of complex pilon fractures: a strategy of soft tissue control. Ind J Orthop 47(5):487–492CrossRefGoogle Scholar
  33. 33.
    Kiene J, Herzog J, Jürgens C et al (2012) Multifragmentary tibial pilon fractures: midterm results after osteosynthesis with external fixation and multiple lag screws. Open Orthop J 6:419–423CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Daghino W, Matteotti R, Pinzi D et al (2011) La configurazione “tripolare” del fissatore esterno temporaneo nel trattamento in due stadi delle fratture di pilone tibiale. Aggiornamenti CIO 17(2):37–41CrossRefGoogle Scholar
  35. 35.
    Rammelt S, Endres T, Grass R et al (2004) The role of external fixation in acute ankle trauma. Foot Ankle Clin 9(3):455–474CrossRefPubMedGoogle Scholar
  36. 36.
    El-Shazly M, Dalby-Ball J, Burton M et al (2001) The use of trans-articular and extra-articular external fixation for management of distal tibial intra-articular fractures. Injury 32(Suppl 4):SD99–S106CrossRefPubMedGoogle Scholar
  37. 37.
    Di Giorgio L, Touloupakis G, Theodorakis E et al (2013) A two-choice strategy through a medial tibial approach for the treatment of pilon fractures with posterior or anterior fragmentation. Chin J Traumatol 16(5):272–276PubMedGoogle Scholar
  38. 38.
    Mehta S, Gardner MJ, Barei DP et al (2011) Reduction strategies through the anterolateral exposure for fixation of type B and C pilon fractures. J Orthop Trauma 25(2):116–122CrossRefPubMedGoogle Scholar
  39. 39.
    Keita I, Perren SM (2007) Biology and biomechanics in bone healing. In: Ruedi TP, Buckley RE, Moran CG (eds) AO principles of fracture management, 2nd expanded edn. Thieme, New York, pp 9–31Google Scholar
  40. 40.
    Grose A, Gardner MJ, Hettrich C et al (2007) Open reduction and internal fixation of tibial pilon fractures using a lateral approach. J Orthop Trauma 21(8):530–537CrossRefPubMedGoogle Scholar
  41. 41.
    Ito K, Perren S (2009) Biologia e biomeccanica della guarigione dell’osso. In: Ruedi T, Buckley RE, Moran C (eds) Principi AO per il trattamento delle fratture. CIC Edizioni Internazionali, Roma, pp 9–30Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Walter Daghino
    • 1
  • Alessandro Massè
    • 1
  • Daniele Marcolli
    • 2
  1. 1.CTO HospitalUniversity of Turin CTO HospitalTurinItaly
  2. 2.Orthopedic divisionAzienda Ospedaliera Ospedale Civile di LMilanoItaly

Personalised recommendations