RESUMO
To clarify which factors influence the final result of surgical management of plafond or pilon fractures, thirty two pilon fractures in 32 patients were treated by open reduction and internal fixation using low profile plates. C.T was obtained before definitive surgery. Management was based on the degree of soft tissue compromise and the type of pilon fracture. Nine patients with Tscherne Grades 0 and l closed injuries underwent immediate open reduction and internal fixation. Seventeen patients with Tscherne Grades II and III underwent temporary stabilization either by splint or calcanean traction for an average duration 13 days before surgery. Four patients presented with open injuries and two patients presented with compartment syndrome, they underwent irrigation, deperidment and fasciotomy then a two pin external fixator was applied for an average 20 days before surgery. Clinical and radiographic evaluations were performed at an average twenty six months after surgery. The radiological score of quality of reduction was anatomic in twenty two cases [68.75%], good in five cases [15.62%], fair in four cases [12.5%] and poor in one case [3.12%]. The clinical outcome was excellent in eighteen cases [56.25%], good in seven cases [21.87%], fair in 5 cases [15.62%] and poor in two cases [6.25%]. There was no iatrogenic injury to the neurovascular bundle. Superficial wound edge necrosis was noted in three cases which healed later without further procedure. Two cases developed deep venous thrombosis. two cases showed delayed union one case of nonunion. No deep infection, or systemic sepsis was ported. Open reduction and stable internal fixation through postero-medial-anterior approach for pilon fractures can ensure anatomic restoration of the articular surface of the distal tibia and early motion of the ankle joint