Background: Under optimal conditions, fractures of the tibial pilon can be definitively managed operatively within 6 h after the trauma. Under suboptimal conditions, preoperative antiphlogistic treatment, possibly after approximate correction and external fixation of the alignment, is a reasonable option. Osteosynthesis implies reconstruction of good joint congruency in anatomical orientation. The soft tissue coverage of the distal lower leg is relatively poorly constructed and there is a high risk of devascularization, necrosis and ensuing infection.
Therapy: Several local accesses with complete visual control of the joint surface enable a strain-free soft tissue handling and thus reduction of the incidence of complications. Besides a specific access to the fibula fracture, two anterior and two posterior accesses are proposed based on normal vascularization. These accesses can be simultaneously combined. Using a bone distractor facilitates control of the joint surface.
Conclusion: Open reduction and stabilization of pilon fractures enables rapid restoration of joint mobility. After having analyzed the fracture and setting the priorities, the treatment strategy should include a well-thought out selection of possible accesses.
Keywords: Bone distractor; Open reduction internal fixation; Soft tissue handling; Strain; Surgical access.