[Update of Pilon fracture classification]

An ideal fracture classification system facilitates stratified diagnosis, standardized treatment, prognostic prediction, scientific research, peer communication, and health education. All of them were particularly important for the management of Pilon fractures. Currently, Pilon fracture classifications were commonly based on plain radiographs and CT scans. The former included the Rüedi-Allgöwer, Kellam-Waddell, Ovadia, AO/OTA, and Letts classifications, which were convenient for assessing general fracture morphology, evaluating alignment, and deducing injury mechanisms. However, they were limited in visualizing articular surface, planning surgical approaches and fixation strategies. The latter included Topliss, four-column, three-column, and Leonetti classifications, which offer advantages in evaluating articular surface fractures, and in guiding surgical approaches and internal fixation strategies, but lack description of the spatial configuration of fracture surfaces. At present, no existing classification system incorporated all the elements required of an ideal system, and none achieve both satisfactory reliability and validity simultaneously. One alternative approach was to use two or more classification systems concurrently, leveraging their respective strengths and compensating for their weaknesses to provide more optimal guidance for clinical planning. Therefore, this article reviewed the commonly used Pilon fracture classification systems for clinical reference and to support further research.