Pilon Fractures of the Distal Tibia: A Test of Surgical Judgment

Conference paper


Intra-articular fractures of the distal tibia are difficult fractures to manage [1, 6–11, 13, 31, 40]. In the 1960s, in the hands of certain members of the AO group, successful surgical treatment of this group of fractures was carried out. By the 1970s, papers on operative management based on the AO principles began to appear in the British orthopedic literature [14, 15, 34–37]. These clinical studies were optimistic about what might be expected to be achieved by the application of the AO group’s methods. Until these references appeared British literature on the pilon fracture was, at best, cautionary to pessimistic. Jergesen, of California, typified this thinking when in his article “Fractures of the Ankle”, written in 1959 [19], he stated that “explosion fractures of the distal end of the tibia were not amenable to open reduction and internal fixation”. Later papers by Leach [23], Sheck [39] and Rouff and Shnider [4] tried to illustrate through limited clinical studies, techniques that had been helpful to the authors in their attempts to salvage ankles in patients with these fractures. These techniques were directed toward internal fixation of the fibula as an isolated event, and preoperative planning with isolated percutaneous fixation of the major articular fragments.


Internal Fixation Distal Tibia Ankle Fracture Posterior Tibial Tendon Cancellous Bone Graft 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Ashurst A, Bromer R (1922) Classification and mechanisms of fractures of the leg bones involving the ankle. Arch Surg 4:51CrossRefGoogle Scholar
  2. 2.
    Bone L (1987) Fractures of the tibial plafond. The pilon fractures. Orthop Clin North Am 18:95–104PubMedGoogle Scholar
  3. 3.
    Border J, Allgöwer M, Hansen S, Rüedi T. Blunt multiple trauma. Dekker, New York, pp 441–448Google Scholar
  4. 4.
    Bourne RB, Rorabeck CH, Nacnab J (1983) Intraarticular fractures of the distal tibia; the pilon fracture. J Trauma 23:591–596PubMedCrossRefGoogle Scholar
  5. 5.
    Brooker AG, Edwards CC (1979) External fixation — current state of the art. Williams and Wilkins, BaltimoreGoogle Scholar
  6. 6.
    Burwell HN, Charnley AD (1965) The treatment of displaced fractures at the ankle by rigid internal fixation and early joint movement. J Bone Joint Surg 47:634Google Scholar
  7. 7.
    Childress HM (1976) Vertical transarticular pin fixation for unstable ankle fractures. Clin Orthop Rel Res 120:164Google Scholar
  8. 8.
    Coonrad RW (1970) Fracture-dislocations of the ankle joint with impaction injury of the lateral weight bearing surface of the tibia. J Bone Joint Surg 52:1337PubMedGoogle Scholar
  9. 9.
    Dabezies E, D’Ambrosia R, Shoji H (1978) Classification and treatment of ankle fractures. Orthopedics 1:365Google Scholar
  10. 10.
    Decoulx P, Razemon JP, Rousdelle Y (1961) Fractures du pilon tibial. Rev Chir Orthop 47:563PubMedGoogle Scholar
  11. 11.
    Destot E (1911) Traumatismes de pied et rayons X malléoles, astragale, calcaneum, avant pied. Masson, ParisGoogle Scholar
  12. 12.
    Franklin JL, Johnson KD, Hansen ST (1984) Immediate internal fixation of open ankle fractures; report of thirty-eight cases treated with a standard protocol. J Bone Joint Surg [Am] 66:1349–1356Google Scholar
  13. 13.
    Gay R, Evard J (1961) Les fractures récentes du pilon chez l’adulte. Rev Chir Orthop 49:397Google Scholar
  14. 14.
    Hackenbruch W (1977) Die Pilon-Fraktur des Skifahrers. Fortschr Med 95:219 (English abstr)PubMedGoogle Scholar
  15. 15.
    Heim V, Naser M (1876) Die operative Behandlung der Pilon-Tibial-Fraktur. Technik der Osteosynthese und die Resultate bei 128 Patienten. Arch Orthop Unfallchirurg 86:341 (English abstr)CrossRefGoogle Scholar
  16. 16.
    Heim V, Pfeiffer KM (1974) Small fragment set manual. Springer, Berlin Heidelberg New YorkCrossRefGoogle Scholar
  17. 17.
    Montzsch D, Karnatz N, Jansen T (1990) One- or two-step management (with external fixator) of severe pilon-tibial fractures. Aktuel Traumatol 20:199–204Google Scholar
  18. 18.
    Jahna H, Wittich H, Hartenstein H (1980) Der distale Stauchungsbruch der Tibia. Unfallheilkunde [Suppl] 137:1Google Scholar
  19. 19.
    Jergesen F (1959) Fractures of the ankle. Am J Surg 98:136PubMedCrossRefGoogle Scholar
  20. 20.
    Kellam JG, Waddell JP (1979) Fractures of the distal tibial metaphysis with intra-articular extension: the distal tibial explosion fracture. J Trauma 19:593PubMedCrossRefGoogle Scholar
  21. 21.
    Lauge-Hansen N (1952) Fractures of the ankle: IV. Clinical use of genetic Roentgen diagnosis and genetic reduction. Arch Surg 64:488CrossRefGoogle Scholar
  22. 22.
    Lauge-Hansen N (1953) Fractures of the ankle: V. Pronation-dorsiflexion fracture. Arch Surg 67:813CrossRefGoogle Scholar
  23. 23.
    Leach IRE (1964) A means of stabilizing comminuted distal tibial fractures. J Trauma 4:722PubMedCrossRefGoogle Scholar
  24. 24.
    Maale G, Seligson D (1980) Fractures through the weightbearing surface of the distal tibia. Orthopedics 3:517Google Scholar
  25. 25.
    Mast JW, Spiegel PG (1984) Complex ankle fractures. In: Meyers MH (ed) The multiply injured patient with complex fractures. Lea and Febiger, PhiladelphiaGoogle Scholar
  26. 26.
    Mast J, Spiegel PG, Pappas J (1988) Fractures of the tibial pilon. Clin Orthop 230:68–82PubMedGoogle Scholar
  27. 27.
    Mast JW (1987) Reduction techniques in fractures of the distal tibial articular surface. Techniques Orthop Surg 2/3:29–36CrossRefGoogle Scholar
  28. 28.
    Mast JW, Jakob R, Ganz R (1989) Planning and reduction techniques in fracture surgery. Springer, Berlin Heidelberg New YorkCrossRefGoogle Scholar
  29. 29.
    Müller ME, Allgöwer M, Schneider R, Willenegger H (1990) Manual of internal fixation, 3rd edn. Springer, Berlin Heidelberg New YorkGoogle Scholar
  30. 30.
    Nelson MC, Jensen NK (1940) The treatment of trimalleolar fractures of the ankle. Surg Gynecol, Obstet 71:509Google Scholar
  31. 31.
    Ovadia DN, Beals RK (1986) Fractures of the tibial plafond. J Bone Joint Surg [Am] 68:543–551Google Scholar
  32. 32.
    Pankovich MM (1979) Adult ankle fractures. J Cont Med Educat Orthop 3:17Google Scholar
  33. 33.
    Pierce RO Jr, Heinrich JH (1979) Comminuted intra-articular fractures of the distal tibia. J Trauma 19:828PubMedCrossRefGoogle Scholar
  34. 34.
    Rouff AC III, Snider RK (1971) Explosion fractures of the distal tibia with major articular involvement. J Trauma 11:866CrossRefGoogle Scholar
  35. 35.
    Rüedi T, Allgöwer M (1979) The operative treatment of intra-articular fractures of the lower end of the tibia. Clin Orthop Rel Res 138:105Google Scholar
  36. 36.
    Rüedi T, Allgöwer M (1969) Fractures of the lower end of the tibia into the ankle joint. Injury 1:92CrossRefGoogle Scholar
  37. 37.
    Rüedi T, Allgöwer M (1978) Spätresultate nach operativer Behandlung der Gelenkbrüche am distalen Tibiaende. Sog. Pilon-Frakturen. Unfallheilkunde 81:319 (English abstr)PubMedGoogle Scholar
  38. 38.
    Rüedi T (1973) Fractures of the lower end of the tibia into the ankle joint, results nine years after open reduction and internal fixation. Injury 5:130PubMedCrossRefGoogle Scholar
  39. 39.
    Scheck M (1965) Treatment of comminuted distal tibial fractures by combined dual pin fixation and limited open reduction. J Bone Joint Surg [Am] 47:1537Google Scholar
  40. 40.
    Tscherne H, Gotzen L (1984) Fractures with soft tissue injuries. Springer, Berlin Heidelberg New YorkCrossRefGoogle Scholar
  41. 41.
    Teeny SM, Wiss DA (1991) Open reduction and internal fixation of tibial plafond fractures: variables contributing to poor results and complications. Presented at annual meeting of American Academy of Orthopedic SurgeonsGoogle Scholar
  42. 42.
    Trojan E, Jahna H, Wittich H, Hartstein H (1980) Der distale Stauchungsbruch der Tibia. Unfallheilkunde [Suppl] 137:1Google Scholar
  43. 43.
    Weber BG (1972) Die Verletzungen des oberen Sprunggelenkes. Han Huber, StuttgartGoogle Scholar
  44. 44.
    Weber BG, Brunner CF (1982) Special techniques in internal fixation. Springer, Berlin Heidelberg New York, pp 115–132, 176–179Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1993

Authors and Affiliations

  • J. Mast

There are no affiliations available

Personalised recommendations