[One- or two-step management (with external fixator) of severe pilon-tibial fractures]

Pilon tibiale fractures with significant joint involvement (AO-classification B2/3 and C2/3) are considered one of the most unfavourable injuries of the lower extremity. It was possible for follow-up examinations to be performed on 50 patients with this injury pattern from the years 1984 to 1988. Primary plate osteosynthesis is primary blamed for causing a high infection rate. Remaining functional losses, uneven joints, defective positionings and early arthrosis are not avoidable with either a one step or a two step approach. The infection rate could be significantly lowered through a two step approach with primary stabilization through an external fixator, without having to accept further disadvantages. An early change of procedure in suitable cases between the second and third week guarantees an internal osteosynthesis with the best possible anatomic reposition of articular surface and axes. In chosen cases an end treatment is possible with an external fixator. The road is open for a primary arthrodesis of irreparably damaged articular surfaces.