Surgical approach in difficult tibial pilon fractures.

The aim of the present study is to emphasize the optimal moment and approach for tibial pilon complex fractures and their complications.We have investigated and treated 7 patients with complex fractures of the tibial pilon with tendencies to complications. According to AO classification,we have recorded 4 fractures type 43C2 AO, 2 fractures type 43C3 AO (with one open fracture type IIIA Gustilo) and 1 fracture type 43B3 AO. According to soft tissue status, surgical treatment was performed by a one-step or two-step approach.All fractures healed after an interval of 13.6 weeks(range 8-28 weeks) with one delayed consolidation. The open fracture was complicated by posttraumatic arthrosis. No infections or implant failures were recorded. According toOvadia score, objective and subjective evolution showed good results in 5 cases, one excellent result and one poor result.Fracture type and the soft tissue status are crucial for the results of operated fractures. These arguments determine the application of one-step or two-step surgical procedure as well as optimal implant choice.