title: Total fractures of the tibial pilon.
abstract: Complete fractures of the tibial pilon are rare and their treatment difficult. The pathophysiology includes three groups: (A) high-energy trauma (motor vehicle injuries), with severe articular and soft tissue lesions, (B) rotation trauma, (skiing accidents), with modest articular and soft tissue damage, and (C) low-energy trauma in elderly people. These three groups occasion very different problems and complications. In emergency situations, these fractures should be stabilized, most often using external fixation to restore length and prepare definitive fixation. The second stage can be applied once soft tissue healing is achieved. Two methods are discussed: internal plating and definitive external fixation. The first goal of treatment is to restore the articular surface, although this does not always prevent secondary arthritis. The second is to restore correct positioning of the foot as regard to the leg. The complication rate is high. Neither of the two fixation techniques has proven to be more effective. In group B, the two methods are similar, but external fixation seems to be safer in group A.
authors.affiliation: Service d'orthopédie-traumatologie, CHU de Rouen, 76031 Rouen, France. Electronic address: Franck.dujardin@chu-rouen.fr.
authors.forename: F
authors.initials: F
authors.lastname: Dujardin
authors.affiliation: Service d'orthopédie-traumatologie, CHU de Rouen, 76031 Rouen, France.
authors.forename: H
authors.initials: H
authors.lastname: Abdulmutalib
authors.affiliation: Service d'orthopédie-traumatologie, CHU de Rouen, 76031 Rouen, France.
authors.forename: A C
authors.initials: AC
authors.lastname: Tobenas
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D000368:Aged; D016512:Ankle Injuries / Q000145:classification / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery*; D001265:Athletic Injuries / Q000145:classification / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D001860:Bone Plates; D016267:External Fixators; D005593:Fracture Fixation, Internal / Q000379:methods; D005597:Fractures, Open / Q000145:classification / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D006801:Humans; D057072:Intra-Articular Fractures / Q000145:classification / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery*; D058866:Osteoporotic Fractures / Q000145:classification / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D012086:Reoperation; D012865:Skiing / Q000293:injuries; D013978:Tibial Fractures / Q000145:classification / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D014057:Tomography, X-Ray Computed
keywords: Complications; External fixation; Synthesis; Tibial pilon