Contemporary Strategies in Pilon Fixation.

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Abstract

[Indexed for MEDLINE] 19. Int Orthop. 2026 May 7. doi: 10.1007/s00264-026-06828-w. Online ahead of print. Reconstruction strategy and outcomes for anterior impaction pilon fractures. Nishizawa G(1)(2), Futamura K(3), Izawa Y(3), Nishida M(3), Inagaki N(4), Saito M(4). Author information: (1)Department of Trauma Center, Shonan Kamakura General Hospital, Kamakura, Japan. sasst716@gmail.com. (2)Department of Orthopedic Surgery, The Jikei University School of Medicine, Minatoku, Japan. sasst716@gmail.com. (3)Department of Trauma Center, Shonan Kamakura General Hospital, Kamakura, Japan. (4)Department of Orthopedic Surgery, The Jikei University School of Medicine, Minatoku, Japan. BACKGROUND: Anterior impaction pilon fractures (AIPs) are a distinct subtype of tibial pilon fractures caused by axial loading of the ankle in dorsiflexion and are associated with severe anterior plafond comminution, anterior talar subluxation, and a high risk of post-traumatic osteoarthritis (PTOA). Optimal surgical strategies for AIP remain unclear. METHODS: This retrospective case series included 23 consecutive patients with AIP treated surgically between 2013 and 2023 with a minimum follow-up of one year. The treatment strategy consisted of anatomical reduction of the impacted anterior tibial plafond and rafting fixation using an anterolateral distal tibial plate, with supplementary fixation and bone grafting as required. Anterior talar subluxation was assessed using the lateral talar station (LTS) as the difference between injured and contralateral ankles immediately postoperatively (ΔLTS-1) and at one year (ΔLTS-2). Clinical outcomes included bone union, the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot score, ankle range of motion, PTOA graded by the modified Kellgren-Lawrence scale, and complications. RESULTS: Mean ΔLTS-1 and ΔLTS-2 were 0.77 ± 1.8 mm and 0.5 ± 2.3 mm, respectively, with no significant difference (p = 0.33). Bone union was achieved in all cases. PTOA developed in 9 patients, with a mean modified Kellgren-Lawrence grade of 0.8 ± 1.2. The mean AOFAS score was 91.6 ± 9.6. Deep infection occurred in three patients, and five required soft-tissue reconstruction. CONCLUSION: Anatomical reduction of the anterior plafond combined with stable anterolateral rafting fixation maintained talar alignment and produced favourable short-term clinical outcomes in patients with AIP. © 2026. The Author(s) under exclusive licence to SICOT aisbl. DOI: 10.1007/s00264-026-06828-w