Early operative management of pilon fractures using the anterolateral approach: a case series

Background: Pilon fractures is a management challenge due to complexity of fracture pattern and complications. The soft tissue state and its subsequent handling is crucial in its outcome. The approach overlying the subcutaneous border of the tibia has wound healing complications. The anterolateral approach has become popular as it offers improved soft tissue coverage leading to fewer wound complications but it is dictated by the fracture pattern and the anterolateral plate use. Additional exposures may be required to address other areas, such as the medial malleolus which cannot be accessed through this approach. Objective: To report the results of patients with pilon fractures who were operated using the anterolateral approach. Methods: Review of patients who underwent antero-lateral plating for pilon fractures. Results: Six patients were assessed retrospectively following antero-lateral plating. Five patients were operated within 24 hours and 1 operated after 10 days due to athletes’ foot. Out of the 6 patients 2 were put on external fixator for reduction purpose away from the plating site. A standard antero-lateral approach was done to plate the distal tibia in all patients, a separate medial incision to plate the medial malleolus was used depending on the fracture pattern and a lateral incision to plate the fibula in all cases. All had good results radiologically and clinically. There were no wound healing problems. Conclusion: Early operative management of pilon fractures using an anterolateral approach provides excellent exposure for accurate fracture reduction and no wound complications in our case series but warrants further evaluation with a larger study population before establishing it as the treatment of choice in our environment.