[Pilon fractures. Part 2: Repositioning and stabilization technique and complication management]

Area of Science:

• Orthopedic Surgery
• Trauma Management

Background:

• Complex pilon fractures with soft tissue injuries present significant management challenges.
• Traditional approaches have evolved towards staged protocols and minimally invasive techniques.

Purpose of the Study:

• To review current trends and outcomes in managing complex pilon fractures with associated soft tissue injuries.
• To highlight advancements in surgical techniques and their impact on complication rates.

Main Methods:

• Review of evolving management strategies including staged protocols, external fixation, delayed open reduction and internal fixation (ORIF).
• Inclusion of minimally invasive percutaneous plate osteosynthesis (MIPPO) and negative pressure wound therapy.
• Emphasis on early soft tissue reconstruction ('fix and flap') and careful handling to minimize complications.

Main Results:

• Adoption of staged protocols and advanced techniques has led to reduced rates of soft tissue complications, infections, and non-unions.
• Focus on anatomical reconstruction of the articular surface and distal tibia/fibula geometry is crucial.

Conclusions:

• Current management trends have improved outcomes for complex pilon fractures with soft tissue injuries.
• The precise degree of articular reduction needed for optimal clinical results requires further investigation, as radiographic perfection does not always correlate with clinical outcomes.