Acta Ortopédica Mexicana

Herrera-Pérez M, Andarcia-Bañuelos C, Ayala-Rodrigo Á, País-Brito JL
Our experience with orthopedic damage control in high-energy tibial pylon fractures
Acta Ortop Mex 2013; 27 (2)

Language: Español
References: 25
Page: 71-77
PDF: 99.15 Kb.

[Fulltext - PDF]


High-energy tibial pylon fractures represent some of the most severe injuries of the ankle joint and currently represent a challenge for the orthopedic surgeon. These are usually polytraumatized patients and before admitting them into the traumatology unit, spinal cord, pelvic or thoracoabdominal injuries should be ruled out. Due to the special anatomy of the area, its thin skin cover and subcutaneous location, soft tissues are usually severely affected and this is key when choosing the time for a surgical intervention. Although the definitive treatment of these injuries is controversial, the so called two-stage treatment seems to predominate in order to minimize soft tissue iatrogenic injuries applying the concept of orthopedic damage control of the limb. We present the preliminary results of 10 patients operated with this method at our center.

Key words: fracture, tibial bone, ankle, prevention, surgery, trauma damage control.


  1. Saura Sánchez E, Delgado Martínez, A: Controversias en cirugía ortopédica y traumatología. Fracturas de pilón tibial. Medical & Marketing Communications. España. 2005.

  2. Crist BD, Khazzam M, Murtha YM, Della Rocca GJ: Pilon fractures: advances in surgical treatment. J Am Acad Orthop Surg 2011; 19: 612-22.

  3. Mauffrey C, Vasario G, Battiston B, Lewis C, Beazley J, Seligson D: Tibial pilon fractures: a review of incidence, diagnosis, treatment and complications. Acta Orthop Belg 2011; 77: 432-40.

  4. Thordarson DB: Complications after treatment of tibial pilon fractures: prevention and management strategies. J Am Acad Orthop Surg 2000; 8: 253-65.

  5. Borrelli J, Ellis E: Tratamiento de fracturas complejas: fracturas de pilón tibial. Orthop Clin North Am (Edición Española) 2002; 2(1): 237-252.

  6. Müller ME, Allgöwer M, Schneider R, Willenegger H: Manual of internal fi xation: techniques recommended by the AO–ASIF Group. 3rd ed. New York: Springer-Verlag; 1991.

  7. Gustilo RB, Merkow RL, Templeman D: The management of open fractures. J Bone Joint Surg 1990; 72: 299-304.

  8. Oestern HJ, Tscherne H: Pathophysiology and classifi cation of soft tissue damage in fractures. Orthopade 1983; 12(1): 2-8.

  9. Tornetta P III: Axial computed tomography of pilon fractures. Clin Orthop 1996; 323: 273-76.

  10. Wolinsky PR, Webb LX, Harvey EJ, Tejwani NC. The mangled limb: salvage versus amputation. In: Instr Course Lect. Am Acad Orthop Surg 2011; 60: 27-34.

  11. Sirkin M, Sanders R, DiPasquale T, Herscovici D: A staged protocol for soft tissue management in treatment of complex pilon fractures. J Orthop Trauma 1999; 13: 78-84.

  12. Anglen JO: Early outcome of hybrid external fi xation for fracture of the distal tibia. J Orthop Trauma 1999; 13(2): 92-97.

  13. Patterson MJ, Cole JD: Two staged delayed open reduction and internal fixation of severe pilon fractures. J Orthop Trauma 1999; 13: 85-91.

  14. Varela CD, Vaughan TK, Carr JB, Slemmons BK: Fractures blisters: clinical and pathological aspects. J Orthop Trauma 1993; 7: 417-27.

  15. Calori GM, Tagliabue L, Mazza E et al. Tibial pilon fractures: which method of treatment ? Injury 2010; 41: 1183-90.

  16. Blauth M, Bastian L, Krettek C, Knop C, Evans S: Surgical options for the treatment of severe tibial pilon fractures: a study of three techniques. J Orthop Trauma 2001; 15: 153-60.

  17. Wiss D, What’s new in orthopedic trauma? J Bone Joint Surg Am 2001; 83: 1762-72.

  18. DiChristina D, Riemer BL, Butterfi eld SL, Burke CJ 3rd: Pilon fractures treated with an articulated external fi xator: a preliminary report. Orthopedics 1996; 19: 1019-24.

  19. Mehta S, Reilly MC, Rhorer AS, Liporace FA. Current plating techniques and defi nitive treatment options for frac-tures of the tibial plafond and treatment of the late and failed pilon. AAOS 2011 Annual Meeting Instructional Course 2011, San Diego Convention Center.

  20. Marsh JL, Weigel DP, Dirschl DR: Tibial plafond fractures: how do these ankles function over time? J Bone Joint Surg Am 2003; 85: 287-95.

  21. Chen SH, Wu PH, Lee YS. Long-term results of pilon fractures. Arch Orthop Trauma Surg 2007; 127: 55-60.

  22. Copin G: Tibial pilon fractures in the adult (in French). Rev Chir Orthop Reparatrice Appar Mot 1992; 78: 33-83.

  23. Papadokostakis G, Kontakis G, Giannoudis P, Hadjipavlou A. External fi xation devices in the treatment of fractures of the tibial plafond: a systematic review of the literature. J Bone Joint Surg 2008; 90: 1-6.

  24. Pollak AN, McCarthy ML, Bess RS, Agel J, Swiontkowski MF: Outcomes after treatment of high-energy tibial plafond fractures. J Bone Joint Surg 2003: 85: 1893-900.

  25. DeCoster TA, Willis MC, Marsh JL, et al: Rank order analysis of tibial plafond fractures: does injury or reduction predict outcome? Foot Ankle Int 1999; 20(1): 44-9.