[Pilon fractures. Part 2: Repositioning and stabilization technique and complication management].

The management of complex pilon fractures with soft tissue injuries has seen many trends, with changes toward staged protocols of temporary external fixation followed by delayed open reduction and internal fixation (ORIF), minimally invasive percutaneous plate osteosynthesis (MIPPO) techniques and special implants, the benefits of negative pressure wound sealing and early "fix and flap" efforts to reconstruct soft tissue defects. Reduction and fixation must involve cautious management and careful handling of soft tissue in order to minimize the well-known complications of this difficult fracture. With these changes, the rate of soft tissue complications, infections and non-unions has decreased. The target remains the anatomical reconstruction of the articular surface as well as the geometric integrity of the distal tibia and fibula. Currently it is still unclear how much articular anatomy and perfection in reduction is needed as the radiographic results do not always correlate with the clinical results.