Pilon fractures present a unique challenge to the patient and orthopaedic surgeon. Care for the soft tissue envelope is as important as management of this articular fracture. Assessment of the degree of energy causing the fracture and careful planning of the joint reconstruction will lead to acceptable results in most cases.

Forty-five patients (AO-ASIF classification) treated between 2003 and 2008 were examined clinically and radiologically at an average of 24 months after injury. The patients were treated in three different ways: primary internal fixation with a plate following, which was reserved for patients with closed fractures without severe soft tissue trauma; one-stage minimally invasive osteosynthesis for reconstruction of the articular surface with long-term transarticular external fixation of the ankle for at least eight weeks and hybrid external fixation. Objective evaluation criteria were infection rate, pseudarthrosis, amount of posttraumatic arthritis, range of ankle movement.

In 65% of all pilon tibial fractures we observed an uncomplicated course of healing. Early complications were mainly soft tissue infections, whereas we found pseudarthrosis to be the most frequent late complication.

The complication rate depends mainly on the type of fracture, the soft tissue damage and the type of treatment. In the case of low-grade soft tissue damage, good to excellent results were accomplished. In the case of higher-grade soft tissue damage, the problem of soft tissue coverage and reconstruction of the joint surface could be solved with good results by the hybrid external fixation. Herewith it is important to use limited open reduction of displaced fragments and fixation by cannulated screws and K-wires