Intra‐Articular Distal Tibia (Pilon/Plafond) Fractures

This chapter presents a case scenario of a 30‐year‐old man who was involved in a motor vehicle accident comes in as a trauma team activation. He is diagnosed with a distal tibia intra‐articular fracture on x‐ray. Open reduction and internal fixation is easiest to perform immediately after injury and before the development of organizing hematoma, soft tissue contraction, callus formation, and inflammatory osteopenia. In high‐energy pilon fractures, the soft tissue envelope has been damaged by the injury. The computed tomography scan must be reviewed carefully as part of surgical planning for both reduction and fixation strategies. A prospective cohort and a comprehensive systematic review have assessed the impact of surgical approach on wound and fracture healing in pilon fractures. External fixation with limited internal fixation is a widely accepted mode of definitive treatment in pilon fracture management. The chapter provides recommendations for implementing evidence‐based practice in the clinical setting.