The radiograph shows a comminuted pilon fracture, which is associated with high-energy trauma and significant soft tissue injury. The tested concept here is the importance of avoiding definitive reduction and fixation of this high-energy injury, which has been shown to be associated with an increased risk of wound complications and deep infections (as compared to staged treatment with usage of a spanning external fixator).
Nork S: Distal tibia fractures, in Stannard JP, Schmidt AH, Kregor PJ, (eds): Surgical Treatment of Orthpaedic Trauma, ed 1. New York, NY, THieme,2007, pp767-791.
Bartlett CS, Winer LS: Fractures of tibial plafond, in Browner BD, Jupiter JB, Levine AM, et al (eds): Skeletal Trauma: Basic Science, Management, and Reconstruction, ed 2. Philadelphia, PA, WB Saunders, 2003, pp2257-2306.
Orthopaedic Knowledge Update 9, Jeffrey S Fischgrund (Editor). Published by American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2008