Medial Column Support in Pilon Fractures Using Percutaneous Intramedullary Large Fragment Fixation

Abstract

Pilon fractures are complex injuries to the tibial plafond requiring stable fixation in the setting of effective soft tissue management, particularly in high-energy injuries, open fractures, or in geriatric individuals. Medial column support of the distal tibial metaphysis is often an essential component when applying balanced fixation. However, the biologic implications of multiple surgical approaches in the setting of damaged tissue, devitalized bone, or significant bone loss may contribute to increased complications. Percutaneous intramedullary large fragment screws offer both stability and a soft tissue-friendly approach for stabilizing the medial column. Here, we present our technique and indications for medial column support in pilon fractures using percutaneous large fragment fixation, along with our early clinical experience in a case series of 7 patients. At minimum 6-month follow-up, all patients healed their injuries with maintained alignment and without complications or further reoperation. Medial column support with percutaneous large fragment fixation in pilon fractures is a viable option to provide mechanical stability while effectively managing tenuous soft tissue envelopes.

Biomechanical evaluation of different medial column fixation patterns for valgus pilon fractures

“…Intramedullary screws have been reported as viable implants for medial column fixation with satisfying early clinical outcomes [ 17 ]. In the wedge-out group of our study, intramedullary screws even showed better stability than plates, which could be explained from three aspects.…”

“…While K-wires, intramedullary screws, and plates are viable options for the fixation of the medial column in pilon fractures, there is currently no consensus on the optimal choice of medial fixation [ 17 , 18 ]. Besides, there is a void in biomechanical studies to evaluate the different medial fixation methods.…”