Fractures of the tibial pilon.

Fractures of the tibial pilon are difficult to manage because of their severity. They are the product of high-energy compression forces and too frequently result in comminution and impaction of the weight-bearing surface of the distal tibia. Other fractures involving the roof of the ankle joint may be called "pilon fractures," but have a better prognosis because the compressive force is coupled with torsional forces. Operative reduction with the application of stable fixation in a clinically proven sequence of steps may lead to a satisfactory outcome in approximately three fourths of the cases, but must be accomplished with a sound understanding of the anatomy of the ankle joint and the principles of stable internal fixation by a surgeon with good atraumatic technique.