The infected pilon: Assessment and treatment strategies

Fractures of the distal tibial plafond (pilon) occur across broad ranges of injury mechanism, severity, and patient demographics. Patients often present with considerably comminuted fracture patterns and significant soft tissue compromise. Surgical intervention must be performed with respect for the exceedingly vulnerable soft tissue envelope and a properly established technical expertise. However, even in the presence of proper timing, favorable host factors, and expert surgical technique, restoration of function and the avoidance of complications may not be achievable. Infection is a relatively common sequela of operative treatment of these fractures and may prove disastrous, eventuating in amputation. Resolution of infection requires a multidisciplinary approach and a compliant patient who embraces the hardships of limb salvage. Surgical treatment of infection requires radical debridement of devitalized soft tissues and osseous structures and their subsequent reconstruction. In some cases, limb amputation may offer the most predictable and beneficial outcome. However, the methods of Ilizarov and their contemporary modifications are uniquely applicable to this complex treatment dilemma and can provide viable options for limb salvage in the setting of the infected pilon fracture.