Introduction: Pilon fractures are severe injuries of the distal tibia usually characterised by severe soft tissue “hit” in addition to the underlying fracture. Historically, plating techniques have led to a significant rate of serious complications. This study describes our early experience treating such injuries by the Ilizarov Method.

Methods: 30 patients were prospectively identified and followed up beyond frame removal clinically and by case note review. Fractures classified according to AO. Bony union evaluated radiologically and clinically – remodelling of bone trabeculae on two radiographs and ability to weight bear without discomfort/walking aids on a dynamised frame.

Results:

Mean age 45.3 years, male: female = 26:4.

Seven fractures were Grade 3 open.

Patients were grouped as follows:

43-A .1/.2/.3 = 1/2/2

Two patients with 43-C.3 fracture had additional corticotomy for bone loss.

Twenty-nine pilons united.

Overall mean time to union was 20 weeks.

Times to union (weeks):

Group 43-A: - median = 20, mean = 21.

24 patients had no major complications. One Grade 3B open 43-C.3 fracture had deep sepsis prior to transfer to our unit which could not be eradicated – this led to transtibial amputation. Two patients had valgus mal-union and One had stiff nonunion requiring a second frame. Eleven patients experienced superficial pinsite infection that resolved with oral antibiotic therapy. Two deep pinsite infections were eradicated by overdrilling.

Conclusion: The Ilizarov method offers safe and reliable healing for distal tibial pilon fractures in mean 20 weeks, with low levels of serious complications despite the severity of the initial injuries.