[Operative access for treatment of pilon fractures]

Under optimal conditions, fractures of the tibial pilon can be definitively managed operatively within 6 h after the trauma. Under suboptimal conditions, preoperative antiphlogistic treatment, possibly after approximate correction and external fixation of the alignment, is a reasonable option. Osteosynthesis implies reconstruction of good joint congruency in anatomical orientation. The soft tissue coverage of the distal lower leg is relatively poorly constructed and there is a high risk of devascularization, necrosis and ensuing infection.

Several local accesses with complete visual control of the joint surface enable a strain-free soft tissue handling and thus reduction of the incidence of complications. Besides a specific access to the fibula fracture, two anterior and two posterior accesses are proposed based on normal vascularization. These accesses can be simultaneously combined. Using a bone distractor facilitates control of the joint surface.

Open reduction and stabilization of pilon fractures enables rapid restoration of joint mobility. After having analyzed the fracture and setting the priorities, the treatment strategy should include a well-thought out selection of possible accesses.