[Pilon fractures : Treatment principles and surgical therapy strategy]

Pilon fractures typically result from high-energy trauma combined with axial compression. The surrounding soft tissues are often severely compromised, complicating treatment. These fractures are best classified according to the Working Group for Osteosynthesis Issues/Orthopedic Trauma Association (AO/OTA) classification system. Even with anatomical reduction of the joint surface there remains a high risk of suboptimal outcome. Advances in implant technology, minimally invasive surgical techniques and strategic management have successfully reduced complication rates in recent years. Despite several adaptations, the principles of Rüedi and Allgöwer remain valid today: correct reconstruction of the fibula (for simple fractures) facilitates subsequent joint reduction. Autologous bone grafts are beneficial in metaphyseal bone defects. Access routes tailored to the soft tissue conditions and fracture pattern enable stabilization, usually with angle stable plates.