International Orthopaedics - 2026-05-07 - Journal Article
Reconstruction strategy and outcomes for anterior impaction pilon fractures.
Nishizawa G, Futamura K, Izawa Y, Nishida M, Inagaki N, Saito M
Topics
Key Takeaway
Anterolateral rafting fixation for anterior impaction pilon fractures achieved 100% union, mean AOFAS 91.6, and maintained talar reduction (mean ΔLTS 0.5 mm at one year) in 23 patients.
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Summary
This retrospective case series evaluated a standardized anterolateral rafting fixation strategy for anterior impaction pilon fractures in 23 patients over a 10-year period. Anatomical reduction with anterolateral distal tibial plating, supplementary fixation, and bone grafting as needed produced 100% union, mean AOFAS 91.6 ± 9.6, and stable talar alignment with no significant change in lateral talar station from immediate postop to one year (ΔLTS-1 0.77 mm vs ΔLTS-2 0.5 mm, p=0.33). PTOA developed in 9 of 23 patients (39%) with a mean modified Kellgren-Lawrence grade of 0.8 ± 1.2; deep infection occurred in 3 patients and 5 required soft-tissue reconstruction.
Key Limitation
With 39% PTOA incidence at minimum one year, the follow-up is too short to determine whether maintained talar alignment translates into reduced rates of end-stage arthritis or altered need for secondary reconstruction.
Original Abstract
BACKGROUND
Anterior impaction pilon fractures (AIPs) are a distinct subtype of tibial pilon fractures caused by axial loading of the ankle in dorsiflexion and are associated with severe anterior plafond comminution, anterior talar subluxation, and a high risk of post-traumatic osteoarthritis (PTOA). Optimal surgical strategies for AIP remain unclear.
METHODS
This retrospective case series included 23 consecutive patients with AIP treated surgically between 2013 and 2023 with a minimum follow-up of one year. The treatment strategy consisted of anatomical reduction of the impacted anterior tibial plafond and rafting fixation using an anterolateral distal tibial plate, with supplementary fixation and bone grafting as required. Anterior talar subluxation was assessed using the lateral talar station (LTS) as the difference between injured and contralateral ankles immediately postoperatively (ΔLTS-1) and at one year (ΔLTS-2). Clinical outcomes included bone union, the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot score, ankle range of motion, PTOA graded by the modified Kellgren-Lawrence scale, and complications.
RESULTS
Mean ΔLTS-1 and ΔLTS-2 were 0.77 ± 1.8 mm and 0.5 ± 2.3 mm, respectively, with no significant difference (p = 0.33). Bone union was achieved in all cases. PTOA developed in 9 patients, with a mean modified Kellgren-Lawrence grade of 0.8 ± 1.2. The mean AOFAS score was 91.6 ± 9.6. Deep infection occurred in three patients, and five required soft-tissue reconstruction.
CONCLUSION
Anatomical reduction of the anterior plafond combined with stable anterolateral rafting fixation maintained talar alignment and produced favourable short-term clinical outcomes in patients with AIP.