Surgical treatment of pilon fracture based on ankle position at the time of injury/initial direction of fracture displacement: A prospective cohort study  Shi-jun Wei, Fang Han, Sheng-hui Lan, Xian-hua Cai  International Journal of Surgery  Volume 12, Issue 5, Pages 418-425 (May 2014) DOI: 10.1016/j.ijsu.2014.03.008 Copyright © 2014 Surgical Associates Ltd Terms and Conditions

Fig. 1 Radiographs and photographs of a 22-year old male who experienced a pilon fracture (AO/OTA type C2) caused by varus injury (a–d). An anteromedial surgical approach was used: The medial part of articular surface was reduced and a buttress plate was placed on the medial aspect of distal tibia (e–g). The fracture successfully healed without complications (h–k). International Journal of Surgery 2014 12, 418-425DOI: (10.1016/j.ijsu.2014.03.008) Copyright © 2014 Surgical Associates Ltd Terms and Conditions

Fig. 2 Radiographs and photographs of a 49-year old male who experienced a pilon fracture (AO/OTA type C3) caused by valgus injury (a–d). A posterolateral surgical approach was used: the fibular fracture was reduced and fixed, then, an anterior approach was used for placement of a major plate on the anterolateral aspect of the distal tibia (e–g). The fracture successfully healed with early minor wound complications (h–k). International Journal of Surgery 2014 12, 418-425DOI: (10.1016/j.ijsu.2014.03.008) Copyright © 2014 Surgical Associates Ltd Terms and Conditions

Fig. 3 Radiographs and photographs of a 43-year old male who experienced a pilon fracture (AO/OTA type B3) caused by dorsiflexion injury (a–d). An anterior surgical approach was used: the posterior part of the articular surface was used for model in reduction and a plate was placed on the anterolateral aspect (e–g). The fracture successfully healed without complications (h–k). International Journal of Surgery 2014 12, 418-425DOI: (10.1016/j.ijsu.2014.03.008) Copyright © 2014 Surgical Associates Ltd Terms and Conditions

Fig. 4 Radiographs and photographs of a 23-year old female who experienced a pilon fracture (AO/OTA type B1) caused by plantarflexion injury (a–d). An anterolateral surgical approach was used: the fibular fracture was reduced and fixed, then a posteromedial approach was used and a major plate was placed on the posterior aspect of the distal tibia (e–g). The fracture successfully healed without complications (h–k). International Journal of Surgery 2014 12, 418-425DOI: (10.1016/j.ijsu.2014.03.008) Copyright © 2014 Surgical Associates Ltd Terms and Conditions

Fig. 5 Radiographs and photographs of a 39-year old male who experienced an open pilon fracture (AO/OTA type C3, Gustilo type II) caused by neutral injury (a–d). External fixation combined with limited internal fixation was performed (e–h). The fracture successfully healed by the 10th after surgery without soft tissue complications (i–l). International Journal of Surgery 2014 12, 418-425DOI: (10.1016/j.ijsu.2014.03.008) Copyright © 2014 Surgical Associates Ltd Terms and Conditions