Primary Arthrodesis for Tibial Pilon Fractures

Primary arthrodesis for pilon fractures can potentially accelerate recovery, decrease complications, and decrease pain compared with open reduction internal fixation in certain scenarios. Indications for primary ankle arthrodesis include 43.B and 43.C fractures that are nonreconstructible, in patients with delay in treatment or multiple medical comorbidities, or in patients with peripheral neuropathy. Initial reduction of the posterior malleolus and fibula can decrease the difficulty of staged ankle arthrodesis. In patients with peripheral neuropathy, increase fixation by adding independent lag screws to an anterior or posterior plate. Alternatively, consider a tibiotalocalcaneal arthrodesis with an intramedullary nail.