Pilon fractures of the tibia: a study based on 19 cases.

Twenty-seven pilon fractures of the tibia were identified from 733 adult tibial and ankle fractures admitted to the Coventry and Warwickshire Hospital in 5 years. Nineteen of the 27 were reviewed. The fractures were classified into types I, II and III according to the AO/ASIF system. Treatment was by splintage in plaster-of-Paris or open reduction and internal fixation, and an external fixator for one type III. Non-operative treatment produced good functional results in all type I fractures, poor results in type II and was not applicable to type III. Eight of 11 types II and III fractures, treated by internal fixation achieved good functional results. Hindfoot disability was assessed from subtalar movements. It is concluded that open reduction and internal fixation is indicated in types II and III pilon fractures. Subtalar motion is negligibly restricted in type I fractures, while in types II and III internal fixation is followed by recovery of hindfoot function.