Algoritmo terapeutico nelle fratture del pilone tibiale

Pilon fractures, classified according the AO classification as fracture type 43 C1, C2, C3, very often involve soft tissue damage. Treatment choice is mainly based on the conditions of the soft tissues, in order to minimize the risk of major complications, responsible for adverse clinical outcome. A pilon fracture with minimal soft tissue damage is best treated by internal fixation. When the soft tissues are significantly involved, a tissue sparing technique, represented by a bridging external fixator, is preferable. After a CT study of the fracture, the final treatment should be performed as soon as the skin and surrounding tissues have reached a normal shape and structure by using either the internal fixation or hybrid external fixation, according to the residual risk of infectious complication and the fracture pattern (i.e. in a C2 fracture internal fixation may be preferable and in a C3 fracture hybrid fixation may be the ideal choice).