Intra-articular fractures of the distal tibia: surgical management by limited internal fixation and articulated distraction.

A series of 12 patients with severe intra-articular (pilon) fractures of the distal tibia were treated by open reduction and internal fixation of the principal articular fragments. Tibial length was restored and maintained by an articulated external fixator which allowed early mobilization of the joint, and associated fibular fractures were fixed internally. Of the patients, nine have been followed up for an average of 33 months (range 18-60 months); three are still undergoing active treatment. Results have been assessed using the scoring system devised by Karlsson and Peterson. Four patients had scores > 80, four had scores between 50 and 79, and one had a score < 50. This technique is less invasive than conventional open procedures that require the use of a tibial plate and may be of particular value in the management of open fractures.