Minimally invasive fixation of tibial pilon fractures

Abstract

Advances in automobile safety and prehospital transport systems have been successful in increasing the survivorship of victims of high-speed motor vehicle accidents. This positive development has led to a changing morphology of fractures to the distal tibial articular surface. The increasingly common pattern of massive articular comminution and extreme soft-tissue damage does not lend itself well to the conventional techniques of open reduction and internal fixation. High complication rates have led orthopedic traumatologists to seek new strategies in the management of these injuries. Common to all of these emerging techniques is the desire to minimize additional soft-tissue injury while satisfying the mandate for articular reconstruction and stable metaphyseal fixation. Limited periarticular incisions have emerged as a method of joint reduction. Several alternative methods for articular support must then be considered. The relative merits and difficulties of bridging external fixation, nonbridging external fixation, delayed open reduction, and subcutaneous plating are discussed.