Minimally Invasive Fixation of Complex Intra-articular Fractures of the Distal Tibial Plafond

Abstract

Plafond fractures are intra-articular fractures of the distal tibia that are usually characterised by major articular comminution and severe soft tissue injury. The surrounding soft tissue envelope must be considered in planning the anatomical reduction of the articular surface. Treatment options include closed reduction, unilateral or circular external fixation, or open reduction and internal fixation (ORIF). Primary arthrodesis is an alternative treatment method recommended by some surgeons for severely comminuted plafond fractures. The Arbeitsgemeinschaft für Osteosynthesefragen (AO) group has reported good results with open reduction of the fibula, medial buttress plating, restoration of the tibiotalar articular surface, and bone grafting, when necessary. However, ORIF may lead to complications such as wound dehiscence, infection, and osteomyelitis. Techniques that combine minimally invasive fixation with external fixation have been developed to avoid these complications. This chapter presents minimally invasive treatment options of tibial pilon fractures, which involves accurate reduction of the joint surface using arthroscopy. This technique also decreases the duration of fluoroscopy time, which helps to limit the radiation dose. © 2025 Elsevier B.V., All rights reserved.