ABSTRACT
Distal tibial fractures (pilon injuries) occur following high-energy trauma in the adult population with extensive soft tissue damage; whereas in the elderly, they present after low-energy trauma with less damage to the surrounding soft tissues. Initial patient assessment should follow the advanced trauma life support guidelines. The presence of deformity indicates substantial fracture displacement/dislocation and should be reduced promptly to allow resuscitation of the soft tissue envelope. Initial plain anteroposterior, lateral, and mortice view radiographs help to appreciate the fracture pattern, but a computed tomography scan is mandatory in depicting the accurate fracture pattern. Undisplaced fractures can be treated nonoperatively with a well-padded plaster. Extra-articular fracture patterns can be stabilized with intramedullary nailing or plating devices. Intra-articular fractures, partial or complete articular, require anatomical reduction and early range of motion as per the AO principles of management. Staged treatment allows soft tissues to improve from the initial injury and makes surgical treatment safer. Delicate soft tissue envelope and bone fragility require special attention in the elderly.
