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Open Reduction and Internal Fixation of Pilon Fracture

intermediate Level

Primary Indication

Displaced tibial plafond fracture

Danger Structures

  • undefined - Variable based on approach
  • undefined - Surrounding operative field
  • undefined - Bone surface
  • undefined - Joint surfaces if applicable

Visual Atlas

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Step-by-Step Technique

1

Stage 1: Spanning external fixator, fibula ORIF if needed

2

Wait 10-14 days for soft tissue recovery (wrinkle test)

3

Stage 2: Anteromedial and/or anterolateral approach

4

Anteromedial: between tibialis anterior and tibialis posterior

5

Anterolateral: between EHL and EDL

6

Restore fibular length and rotation first (if not done stage 1)

7

Identify and elevate die-punch fragments

8

Reduce articular surface anatomically

9

Bone graft metaphyseal void

10

Apply medial buttress plate

11

Consider posterolateral plate for posterior fragments

12

Intraoperative CT if available to confirm reduction