Intra-articular Osteotomy for Correction of Malunions and Nonunions of the Tibial Pilon.

Malunions of the tibial pilon lead to painful posttraumatic ankle arthritis and malposition of the hindfoot with severe functional disability. Most will need corrective ankle fusion as a salvage procedure. Joint-preserving correction with secondary anatomic reconstruction for intra-articular malunions is possible only in carefully selected patients with intact cartilage, sufficient bone quality, residual function, and good compliance. Osteotomies of solid malunions are planned according to preoperative computed tomography scans. Bone grafting is needed after resection of a fibrous nonunion or sclerotic or necrotic bone. Especially in young patients, anatomic reconstruction of malunited tibial pilon fractures is a viable treatment alternative.