![]() Furthermore, they formulated a treatment plan for each type of pilon fracture ( 12, 13). From the cohort study they conducted they derived a classification system separating pilon fractures into three different categories based on the extent of the comminution and the displacement of the articular surface. Rüedi and Allgöwer were amongst the first trauma surgeons to extensively research pilon fractures. The rate of open fractures varies greatly depending on the mechanism of the injury, with up to 50% reported in high energy traumas ( 11). When the foot is in neutral position at the time of the impact, the talus will act as a pestle, which will result in destruction of the whole articular surface ( 8). Furthermore, when the foot is in plantar flexion at the time of impact the force will likely cause a fracture of the posterior part, when the foot is in dorsiflexion an anterior fracture of the tibial pilon is the result. Sagittal fractures are mostly seen in younger patients and high–energy trauma with the foot in varus angulation at the time of impact, while coronal fractures are rather seen in older patients, with low–energy trauma and the foot in valgus angulation ( 10). emphasize the importance of the position of the foot at the time of axial impact and therefore distinguish between fractures in the sagittal plane and those in the coronal plane. The position of the foot at the time of axial impact seems to be the decisive factor in terms of fracture pattern and amount of comminution ( 9, 10). The high energy surrounding the accidents cause severe damage to the surrounding soft tissue as well and ~6% of all patients with tibial pilon fractures have multiple injuries and require intensive care units ( 7, 8). Most commonly the high–energy traumas are due to falls or jumps from great heights or motor vehicle accidents. Sometimes rather low-energy rotational forces, for example in skiing accidents, can also lead to pilon fractures, but the comminution seen in these fractures is usually less severe ( 5). In contrast to simple ankle fractures, pilon fractures usually result from high-energy trauma with heavy axial force, which basically causes the tibial plafond to burst over the talus ( 7). Furthermore, in recent studies it has been suggested that tibial pilon fractures are likely to be less comminuted and less severe when the fibula remains intact ( 6). Tibial pilon fractures with the fibula intact are more likely in AO Type B fractures than in Type C fractures. In ~75–90% of all cases the fibula is also fractured ( 5). Men tend to suffer from these injuries slightly more often than women with the majority of injuries occurring at around 45 years ( 3, 4). Tibial pilon fractures are quite rare, accounting for ~3–10% of all tibial fractures and <1% of all fractures to the lower extremity ( 1– 3). The aim of this review is therefore to summarize protocols in managing these difficult fractures, review the literature on recent developments and therefore give surgeons a better understanding and ability to handle tibial pilon fractures. Additional methods of treating the soft tissue envelope are currently being investigated and have shown promising results for the future. In the early years of this century treatment has evolved to a two–staged protocol, which nowadays is the gold standard of care. Therefore, long -term outcome is often poor and correct initial management crucial. Especially Type C fractures are extremely difficult to manage as the high energy involved in developing this type of injury frequently damages the soft tissue surrounding the fracture zone severely. Many different classification systems exist so far, with the AO Classification being the most commonly used classification in the clinical setting. This term has further been used to portray the mechanism involved in tibial pilon fractures in which the distal tibia acts as a pestle with heavy axial forces over the talus basically causing the tibia to burst. He used the French word “pilon” (i.e., pestle), to describe the mechanical function of the distal tibia in the ankle joint. Tibial pilon fractures were first described by Étienne Destot in 1911. 3Department of Trauma Surgery, Center for Musculoskeletal Surgery, Charité University Medicine Berlin, Berlin, Germany.2Center for Orthopedic and Trauma Surgery, University Medical Center, Cologne, Germany. ![]() 1Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.Braun 1,3, Chlodwig Kirchhoff 1, Peter Biberthaler 1 and Moritz Crönlein 1 Olivia Mair 1 *, Patrick Pflüger 1, Kai Hoffeld 1,2, Karl F.
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