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Type I: Pilon Frx



- Discussion:
    - articular fracture without significant displacement;
    - malleolar fractures with large plafond fragments;
    - these fragments are usually posterior;
    - posteroinferior tibiofibular ligament & deep transverse ligament are attached to the fragment;
    - first reduce & fix fibula;
          - may usually be accomplished w/ lag screw & neutralization plate;
          - because of the intact state of ligamentous connection to posterior fragment, reduction of fibula usually restores length relationship of posterior plafond fragment;
- distal tibia is exposed;
   - large posterior fragment needs to be identified;
   - large pointed reduction forceps are placed from anterior to posterior, holding the large fragment firmly reduced;
   - fixation should include lag screw placed from posteromedial to posterolateral or posterior;
   - medial malleolar fragment is reduced & fixed w/ lag screw or tension band