Pilon Fractures
A structured review and evidence-based note template
DOI:
https://doi.org/10.55576/job.v6i1.64Keywords:
Pilon fracture, tibial plafond, evidence-based documentation, clinical note template, orthopedic trauma, fracture managementAbstract
Objectives: The purpose of this study is to synthesize Level IV or higher evidence related to tibial plafond (pilon) fractures and to translate this evidence into a standardized, evidence-based clinical note template designed to support consistent evaluation, risk stratification, and treatment planning in orthopedic trauma practice.
Design: Structured literature review with development of an accompanying evidence-based clinical note template.
Main Outcome Measurements: Fracture classification, diagnostic evaluation, treatment strategies, complication rates, functional outcomes, and evidence-supported elements of clinical documentation relevant to pilon fractures.
Results: A structured review of the orthopedic literature identified tibial plafond fractures as complex, high-energy injuries frequently associated with articular comminution, soft-tissue compromise, and concomitant musculoskeletal injuries. The AO/OTA classification system remains the most widely utilized framework for fracture characterization. Evidence supports a range of management strategies, including nonoperative treatment, staged open reduction and internal fixation, circular frame fixation, intramedullary nailing with limited internal fixation, primary hindfoot arthrodesis, and, in rare cases, amputation. High rates of complications persist across treatment modalities, including infection, nonunion, post-traumatic arthritis, and long-term functional impairment. These findings informed the development of a comprehensive, structured clinical note template that incorporates key history, physical examination, imaging, risk factors, and management considerations, supported by current evidence.
Conclusions: Tibial plafond fractures remain among the most challenging injuries in orthopedic trauma, with substantial morbidity despite advances in surgical technique. An evidence-based, standardized documentation approach may improve clinical consistency, facilitate multidisciplinary care, and support evidence-informed decision-making. The accompanying note template provides a practical tool for integrating current evidence into daily clinical practice.
Level of Evidence: Level IV; Structured Review of Level IV or Higher Evidence
Key Words: Pilon fracture, tibial plafond, evidence-based documentation, clinical note template, orthopedic trauma, fracture management
References
REFERENCES
Crist, B.D., et al., Pilon Fractures: Advances in Surgical Management. American Academy of Orthopaedic Surgeon, 2011. 19(10): p. 612-622.
Egol, K.A., K.J. Koval, and J.D. Zuckerman, Handbook of fractures. 2020, Wolters Kluwer,: Philadelphia. p. 1 online resource.
Al-Ashhab, M.E. and S.F. Harwin, Primary Ankle Arthrodesis for Severely Comminuted Tibial Pilon Fractures. Orthopedics, 2017. 40(2).
Bastias, C. and L. Lagos, New Principles in Pilon Fracture Management. Foot and Ankle Clinics, 2020. 25(4): p. 505-521.
BN, S., et al., Pilon Fractures: Challenges and Solutions. Orthopedic research and reviews, 2019. 11.
Polmear MM, et al. Injuries Sustained With Falls From Height in Crossing the United States-Mexico Border at a Level I Trauma Center: A Prospective Cohort Study. J Am Acad Orthop Surg Glob Res Rev. 2023;7(6):e23.00005.
Riva HR, et al. Spine Injuries Sustained After Falls While Crossing the U.S.-Mexico Border. Neurotrauma Rep. 2024;5(1):367-375.
Halvachizadeh, S., et al., The local soft tissue status and the prediction of local complications following fractures of the ankle region. Injury, 2022.
Rüedi, T.P. and M. Allgöwer, Fractures of the lower end of the tibia into the ankle-joint. Injury, 1969. 1(2): p. 92-99.
Luo, D.T., et al., Classifications in Brief: Rüedi-Allgöwer Classification of Tibial Plafond Fractures. Clinical Orthopaedics & Related Research, 2017. 475(7): p. 1923-1928.
Leonetti, D. and D. Tigani, Pilon fractures: A new classification system based on CT-scan. Injury, 2017. 48(10): p. 2311-2317.
Assal, M., A. Ray, and R. Stern, Strategies for Surgical Approaches in Open Reduction Internal Fixation of Pilon Fractures. Journal of Orthopaedic Trauma, 2015. 29(2): p. 69-79.
Chen, H., et al., Staged procedure protocol based on the four-column concept in the treatment of AO/OTA type 43-C3.3 pilon fractures. Journal of International Medical Research, 2019. 47(5): p. 2045-2055.
Olson JJ, et al. Judicious Use of Early Fixation of Closed, Complete Articular Pilon Fractures Is Not Associated With an Increased Risk of Deep Infection or Wound Complications. J Orthop Trauma. 2021;35(6):300-307.
Kim YJ, et al. An Acute Fixation Protocol for High-Energy Tibial Plateau Fractures Decreases Time to Fixation and Lowers Operative Costs Without Affecting Wound Complications and Reoperations. J Orthop Trauma. 2023;37(6):287-293.
Gardner MJ, et al. Treatment protocol for open AO/OTA type C3 pilon fractures with segmental bone loss. J Orthop Trauma. 2008;22(7):451-457.
Malik-Tabassum, K., et al., Post-operative outcomes of open reduction and internal fixation versus circular external fixation in treatment of tibial plafond fractures: A systematic review and meta-analysis. Injury, 2020. 51(7): p. 1448-1456.
Nozaka, K., et al., Effectiveness of Ilizarov external fixation in elderly patients with pilon fractures. J Orthop Sci, 2021. 26(2): p. 254-260.
Marcus, M.S., et al., Is there a role for intramedullary nails in the treatment of simple pilon fractures? Rationale and preliminary results. Injury, 2013. 44(8): p. 1107-1111.
Marcus MS, et al. Is there a role for intramedullary nails in the treatment of simple pilon fractures? Rationale and preliminary results. Injury. 2013;44(8):1107-1111.
Vallier, H.A., T.T. Le, and A. Bedi, Radiographic and Clinical Comparisons of Distal Tibia Shaft Fractures (4 to 11 cm Proximal to the Plafond): Plating Versus Intramedullary Nailing. Journal of Orthopaedic Trauma, 2008. 22(5): p. 307-311.
Ho, B. and J. Ketz, Primary Arthrodesis for Tibial Pilon Fractures. Foot and Ankle Clinics, 2017. 22(1): p. 147-161.
Cinats, D.J., S. Kooner, and H. Johal, Acute Hindfoot Nailing for Ankle Fractures: A Systematic Review of Indications and Outcomes. J Orthop Trauma, 2021. 35(11): p. 584-590.
Zelle BA, et al. Primary Arthrodesis of the Tibiotalar Joint in Severely Comminuted High-Energy Pilon Fractures. J Bone Joint Surg Am. 2014;96(11):e91.
Al-Ashhab ME. Primary Ankle Arthrodesis for Severely Comminuted Tibial Pilon Fractures. Orthopedics. 2017;40(2):e378-e381.
JC, R., et al., The Military Orthopedic Trauma Registry: The potential of a specialty specific process improvement tool. The journal of trauma and acute care surgery, 2016. 81(5 Suppl 2 Proceedings of the 2015 Military Health System Research Symposium).
Anglen, J.O., Early Outcome of Hybrid External Fixation for Fracture of the Distal Tibia. Journal of Orthopaedic Trauma, 1999. 13(2): p. 92-97.
Potter CBK, Bosse MJ. American Academy of Orthopaedic Surgeons Clinical Practice Guideline Summary for Limb Salvage or Early Amputation. J Am Acad Orthop Surg. 2021;29(13):e628-e634.
Thabet AM, et al. Outcomes and Complications With Treatment of Open Tibial Plafond Fractures With Circular External Fixator. Foot Ankle Int. 2021;42(6):723-733.
Patterson, M.J. and J.D. Cole, Two-Staged Delayed Open Reduction and Internal Fixation of Severe Pilon Fractures. Journal of Orthopaedic Trauma, 1999. 13(2): p. 85-91.
Sirkin, M., et al., A Staged Protocol for Soft Tissue Management in the Treatment of Complex Pilon Fractures. Journal of Orthopaedic Trauma, 1999. 13(2): p. 78-84.
Harris, A.M., et al., Results and outcomes after operative treatment of high-energy tibial plafond fractures. Foot Ankle Int, 2006. 27(4): p. 256-65.
Middleton, S.D., et al., Long-Term Trajectory of Recovery Following Pilon Fracture Fixation. J Orthop Trauma, 2022. 36(6): p. e250-e254.
De-las-Heras-Romero, J., et al., Quality of life and prognostic factors after intra-articular tibial pilon fracture. Injury, 2017. 48(6): p. 1258-1263.
Pollak, A.N., et al., Outcomes after Treatment of High-Energy Tibial Plafond Fractures. The Journal of Bone and Joint Surgery-American Volume, 2003. 85(10): p. 1893-1900.
DM, M., et al., Pilon fractures. Clinics in podiatric medicine and surgery, 2012. 29(2).
Falzarano, G., et al., Foot Loading and Gait Analysis Evaluation of Nonarticular Tibial Pilon Fracture: A Comparison of Three Surgical Techniques. The Journal of Foot and Ankle Surgery, 2018. 57(5): p. 894-898.
TEENY, S.M. and D.A. Wrss, Open Reduction and Internal Fixation of Tibial Plafond... : Clinical Orthopaedics and Related Research®. 2024.
McFerran, M.A., et al., Complications Encountered in the Treatment of Pilon... : Journal of Orthopaedic Trauma. 2024.
Lu, V., et al., Open versus closed pilon fractures: Comparison of management, outcomes, and complications. Injury, 2022. 53(6): p. 2259-2267.
Shafiq, B., et al., Reducing Complications in Pilon Fracture Surgery: Surgical Time Matters. J Orthop Trauma, 2023. 37(10): p. 532-538.
O'Toole, R.V., et al., Effect of Intrawound Vancomycin Powder in Operatively Treated High-risk Tibia Fractures: A Randomized Clinical Trial. JAMA Surg, 2021. 156(5): p. e207259.
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