Pylon fractures of the distal tibia.

Forty-two patients with pylon fractures were categorized into Rüedi and Allgöwer Type I (26%), Type II (29%), and Type III (45%) subgroups and assessed. The mean follow-up period was 4.4 years (range, two to eight years). Type I fractures were usually torsion injuries, whereas Types II and III fractures were associated with violence (i.e., motor vehicle accident or fall from a height). Types I and II pylon fractures proved to be amenable to open reduction and restoration of anatomic position, stable internal fixation, early joint motion, and delayed weight bearing. Over 80% of these patients had satisfactory function. Nonanatomic reduction, unstable fixation, infection, nonunion, malunion, and secondary arthrosis were associated with disability from Type III pylon fracture treatment. Only 32% of Type III pylon fracture patients had satisfactory joint function.