The Operative Treatment of Intra-articular Fractures of the Lower End of the Tibia

The intra-articular fractures of the lower end of the tibia, the so-called pilon tibia1 fractures (Fig. l ) , were for many years considered as “not amenable to surgery” and the patients were forced to accept the usually poor late result as a matter of bad luck. And even in those instances whereopen reduction was tried and some sort of mostly inadequate screw or wire fixation was attempted, the results were usually not encouraging (Table 1). The modern concept offracture treatment by means of open, anatomical reconstruction, stable internal fixation and functional aftercare has been able to change this rather fatalistic attitude dramatically (Fig. 2). In 1968/69 we7*8 reported for the first time on a consecutive series of 84 pilon fractures exclusively treated by internal fixation following the four principles of the Swiss Study Group’: (1) Reconstruction of the correct length of the fibula. (2) Reconstruction ofthe articular surface of the tibia. (3) Introduction of a cancellous autograft to fill in the bone defect in the metaphysis of the tibia. (4) Stabilization of the medial aspect of the tibia by a plate. In comparison to the results after conservative or poor operative treatment, our 74% of good and excellent functional results an