The treatment of pilon fractures

Distal tibial fractures represent a significant treatment challenge to most orthopedic surgeons. Pilon fractures represent 1% to 10% of all lower extremity fractures. These fractures can result from low-energy injuries that do not cause significant damage to the soft tissue envelope of the lower leg. Alternatively, the advent of high-speed automotive travel has been accompanied by high-energy distal tibial injuries, which can result in severe soft tissue devitalization. Higher-energy injuries also can induce significant joint surface cartilage damage, leading to posttraumatic arthritis despite optimal articular surface reduction and fixation. This article reviews the evolution of treatment and the current state of the art of pilon fracture management.