title: Treatment of malreduced pilon fracture: A case report and the result in the long-term follow-up.
abstract: BACKGROUND
  The risk for post-traumatic osteoarthritis (POA) following tibial plafond joint trauma has been reported to be as high as 70-75%. In the treatment of more severe joint pathologies, with incongruity and intra-articular defects, internal or external fixations techniques may be required.
  
  
  METHODS
  We report the orthopedic management of a pilon fracture in a 30-year-old male with malunion and implant failure after initial mal-reduction of the fracture 9-months earlier. Tricortical iliac crest autologous bone grafting (TCG) was used in combination with internal fixation to restore distal tibial articular. The procedure resulted in a pain free ankle, sufficient range of motion for function and patient satisfaction.
  
  
  CONCLUSIONS
  Early surgical intervention and anatomical reduction with appropriate fixation are recommended for intra-articular tibial pilon fractures. Autogenous bone grafting is a reliable treatment option to augment structural stability, bone defects and bone-healing. Indications for bone grafting include delayed union or nonunion, malunion, arthrodesis, limb salvage, and reconstruction of bone voids or defects. The application of TCG in the management of a malreduced tibial plafond fracture has not been described before.
  
  
  CONCLUSIONS
  We performed TCG with internal fixation in order to restore stability, congruency and alignment in a young patient in whom a biological restoration was feasible due to good bone quality. In suitable cases, TCG might provide an alternative to arthrodesis or arthroplasty.
authors.affiliation: Baltalimani Metin Sabanci Bone Diseases Training and Research Hospital, Baltalimani, Istanbul, Turkey. Electronic address: mbbalibey@gmail.com.
authors.forename: Mehmet Bulent
authors.initials: MB
authors.lastname: Balioğlu
authors.affiliation: Baltalimani Metin Sabanci Bone Diseases Training and Research Hospital, Baltalimani, Istanbul, Turkey. Electronic address: yemreakman@gmail.com.
authors.forename: Yunus Emre
authors.initials: YE
authors.lastname: Akman
authors.affiliation: Baltalimani Metin Sabanci Bone Diseases Training and Research Hospital, Baltalimani, Istanbul, Turkey. Electronic address: drhakanbahar@gmail.com.
authors.forename: Hakan
authors.initials: H
authors.lastname: Bahar
authors.affiliation: Baltalimani Metin Sabanci Bone Diseases Training and Research Hospital, Baltalimani, Istanbul, Turkey. Electronic address: albayrakakif@gmail.com.
authors.forename: Akif
authors.initials: A
authors.lastname: Albayrak
keywords: Ankle injuries; Autologous bone graft; Intra-articular fractures; Osteoarthritis; Transplantation