[Primary closed, stabilization of type C 3 pilon fractures with external fixator without bridging the ankle joint]

The necessity for a short operative procedure that does not cause additional stress to the soft tissue overlying pylon fractures and at the same time enables the surgeon to reconstruct the distal articular surface of tibia and fibula, which includes achieving the correct length, led us to develop a new procedure in the acute treatment of such fractures. Therefore our operative procedure starts with indirect reduction and stabilization of the fibula by means of intramedullary Kirschner wires. For a precise analysis of the main fracture fragments of the distal tibia, we continue with reduction of the articular surface by means of ligamentotaxis and stabilization with angular external fixator without bridging the ankle joint. Special positioning of the external fixator allows an almost completely percutaneous procedure under X-ray control, and furthermore, control of the alignment of the articular surface of the tibia. At the same time, additional surgical measures, such as spongious bone transfer, grafting of skin flaps or secondary correction of the axis, are possible. In three cases of type C2 pilon fracture reported, healing was achieved within 12 weeks without complications. The range of motion of the ankle joint was preserved by physiotherapy under epidural anesthesia for a period of 5 days postoperatively.