A case of closed reduction through metaphyseal window for a pilon fracture

Abstract

A 52-year-old man presented with painful swelling of his left ankle after a fall from a ladder. The radiograph revealed fractures of the medial and lateral malleoli and a pilon fracture. The lateral portion of the plafond was broken, and the fractured bone fragment was impacted into the metaphysis. The fractured bone fragment was gently tapped through a metaphyseal window to be reduced into the anatomical position, and the joint surface was restored. The channel through which the impactor was introduced was grafted with an autogenous iliac bone graft. The fractured medial and lateral malleoli were stabilized with tension band wiring and plating. The unstable syndesmosis of the ankle mortise was fixed with a transfixation screw. At 6 months after surgery, the motion arc of the ankle ranged from dorsiflexion 20 to plantar flexion 30, and there were minimal difficulties in the activities of daily living. This paper reports a technique for treating a pilon fracture involving the lateral side of the plafond with intact anterior and posterior cortices by a closed reduction through the metaphyseal window. The precarious soft tissue around the ankle joint after a pilon fracture could be spared from additional surgical injury, and the saved soft tissue envelope around the injury could facilitate fracture healing.