Posterior Approaches to Pilon Fractures: Considerations, Indications, and Outcomes

Intra-articular fractures of the distal tibia, termed pilon fractures, represent challenging injuries due to poor soft-tissue envelope, articular and metaphyseal comminution, difficult visualization, and reduction techniques, as well as high rates of complications. Choice of surgical approach has been dictated by location of articular injury, positioning of appropriate fixation and soft-tissue considerations. Posterior column shortening, malalignment or posterior articular comminution/impaction have all warranted consideration for the utilization of a posterior approach. A variety of posterior approaches have been described in the literature, yet limited data exist to guide the decision regarding selection of posterior approaches. This review will detail posterior approaches to tibial pilon fractures, with a focus on described techniques, indications, and comparison between the different posterior approaches and respective outcomes.