Soft tissue management of closed tibial pilon fractures

The management of closed intra-articular pilon fractures has a history of significant postoperative soft tissue complications when managed with open reduction and internal fixation. The classically described early open reduction of the tibia using an anterior approach was found to have an unacceptably high complication rate. It was observed that significant pilon fractures actually involved 2 injury paradigms: one involving bone and the other involving the soft tissue envelope. This led to significant changes in the protocol for managing closed pilon fractures effectively reducing the complication rates involving both soft tissue and bone. Recognition of the soft tissue trauma led to the staging of pilon fractures to allow time for soft tissue recovery from the initial trauma. Recognition of the diversity of the bony injury through the use of computed tomography scans has led to a variety of described approaches that allow the surgeon to choose how best to manage the fracture pattern.