The management of the soft tissues in pilon fractures

Fourteen patients with 15 pilon fractures were reviewed retrospectively to analyze cases treated by open reduction and internal fixation through both anteromedial and lateral incisions. The protocol for this procedure involved objective soft-tissue evaluation, anteromedial wound closure, judicious use of primary skin grafting, and delayed primary or secondary closure for the lateral wound. Eleven fractures were treated according to the established principles of the Association for the Study on Internal Fixation (AO/ASIF). The type and incidence of wound complications were recorded. Most injuries reviewed were of the high-energy or Type III fracture as defined by Reudi and Allgower. There was only one patient with a wound complication. This technique minimized the potential for wound complication and disastrous disability.