JAAOS - 2026-07-15 - Journal Article; Review
Posterior Approaches to Pilon Fractures: Considerations, Indications, and Outcomes.
Tiee MS, Stewart CC, Usmani K
Topics
Key Takeaway
Posterior approaches to pilon fractures address posterior column shortening, malalignment, and articular comminution, but no high-quality comparative data exist to guide selection among the described techniques.
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Summary
This review synthesizes the indications, techniques, and outcomes for posterior surgical approaches to tibial pilon fractures, focusing on posterior column shortening, malalignment, and articular comminution as operative drivers. The authors compare described posterior approaches and their respective fixation strategies. No high-level comparative trials exist; available data are limited to small case series and technique descriptions, precluding definitive recommendations.
Key Limitation
The absence of comparative outcome data with standardized functional scores (e.g., AOFAS, FAAM) across posterior approach types makes it impossible to recommend one technique over another based on this review alone.
Original Abstract
Intra-articular fractures of the distal tibia, termed pilon fractures, represent challenging injuries due to poor soft-tissue envelope, articular and metaphyseal comminution, difficult visualization, and reduction techniques, as well as high rates of complications. Choice of surgical approach has been dictated by location of articular injury, positioning of appropriate fixation and soft-tissue considerations. Posterior column shortening, malalignment or posterior articular comminution/impaction have all warranted consideration for the utilization of a posterior approach. A variety of posterior approaches have been described in the literature, yet limited data exist to guide the decision regarding selection of posterior approaches. This review will detail posterior approaches to tibial pilon fractures, with a focus on described techniques, indications, and comparison between the different posterior approaches and respective outcomes.