Fractures of the tibial plafond. The pilon fracture.

The fracture of the tibial plafond or pilon fracture is an uncommon but difficult fracture to manage. Fracture of the plafond occurs when the talus is driven into the tibia from axial compression. The type of fracture that occurs will depend on the position and rotation of the foot at the time of impact. Historically, these fractures have been treated in a number of manners, but the best results have occurred when stable internal fixation is accomplished using plates and screws. Basic steps in reconstruction are restoration of anatomic length of the fibula with plate fixation, reconstruction of the tibial articular surface, cancellous bone grafting of the metaphyseal defect, and buttress plating either anteriorly or medially of the distal tibia. If anatomic reconstruction of the joint surface can be restored and stable fixation achieved, early motion of the ankle is made possible. This early motion reduces stiffness of the ankle and will yield the most satisfying results.