Abstract

Introduction: Complex tibial pilon fractures represent less than 1% of lower limb fractures. The long-term outcome is often poor and correct initial management is crucial. Their treatment has evolved into a two-stage protocol, which today is the gold standard. The aim of this review is to summarize strategies for the management of these difficult fractures.
Search strategy: References were identified by searching PubMed, Google Scholar and Elsevier for publications between 2013-2025 in English.
Development: There is a broad consensus that surgical fixation and reduction is the treatment of choice for tibial pilon fractures. At present, the criterion of performing surgical treatment in two stages predominates. Several authors recommend primary osteosynthesis of the fibula to achieve a better reduction of anterolateral and posterolateral tibial fragments by means of ligamentotaxia. Applying and following a staged treatment algorithm helps to reduce the rates of complications and failures.
Conclusion: Meticulous planning, respecting the surrounding soft tissues and determining the correct time for osteosynthesis, based on standardized protocols, allow optimizing the final result of this severe injury.

Keywords:Fractures; Tibial pilon; Distal tibia fractures; Intra-articular ankle fractures