Posterior pilon fracture: Epidemiology and surgical technique

• Published in: Injury 2019-12, Vol.50 (12), p.2312-2317
• Main Authors: Chaparro, Felipe, Ahumada, Ximena, Urbina, Christian, Lagos, Leonardo, Vargas, Fernando, Pellegrini, Manuel, Barahona, Maximiliano, Bastias, Christian
• Format: Article
• Language: English
• Subjects: Ankle fracture; Fibular fracture; Posterior malleolar fracture; Posterior pilon fracture; Posteromedial approach; Syndesmotic injury
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2019.10.007

•Posterior malleolar involvement in ankle fractures is a common pattern and must be recognized and treated accordantly in order to achieve good outcomes.•CT-Scan is crucial to adequately recognize fracture pattern and planning surgical fixation.•Is necessary to directly reduce and fix posteromedial fragments as there are no ligamentous attachments for relying on ligamentotaxis. Posteromedial approach is a useful way to accomplish this.•High index of suspicion must be had on syndesmotic instability despite fracture fixation. To review a case series of patients with posterior pilon variant fracture using a novel approach, focusing on demographic data, injury pattern, surgical results based on computed tomography (CT) scan, and short-term complications. Consecutive case series. Level I trauma center. Twenty-five patients with posterior pilon fracture. Posterior pilon fracture open reduction and internal fixation. Parameters measured included age, sex, type of fracture, surgical technique, anatomical reduction, and complications. Twenty-five patients sustained a posterior pilon fracture, accounting for 13.4% of all operatively treated ankle fractures with median follow-up of 21.7 months. The average age of patients was 42 years (22–62); 19/25 (76%) were female, and 6/25 (24%) were male. A modified posteromedial approach was used in 18/25 (72%) patients. Persistent syndesmotic instability was present in 11/25 (44%) patients after posterior malleolar stabilization. Quality of reduction was assessed under CT scan in 19 patients, with 15/19 (78.9%) having anatomic reduction. We report 2/25 (8%) patients with early wound problems and 7/25 (20%) with short-term complications during follow-up. Posterior pilon variant fracture appears to be less common than previously reported. Most fractures can be satisfactorily treated through a modified posteromedial approach. Albeit obtaining posterior malleolar fracture rigid fixation, syndesmotic instability was more prevalent than expected. The short-term complication rate was low. Therapeutic level IV.