Fractures of the tibial pilon remain a complicated situation, due to their articular location in the majority of cases, whose reconstruction in case of fracture of a correct tibioastragalar articular surface constitutes a great challenge for the surgeon. The thin and fragile skin covering the distal part of the tibia further complicates the therapeutic strategy for these fractures, since it is the site of progressive suffering that may require the open site to be removed. In this sense, the treatment of tibial pilon fractures by closed focus osteosynthesis (percutaneous screw fixation more or less pinning on demand or external fixation) has an important place in the therapeutic management of this type of fracture (especially when they are open or associated with significant skin damage). Closed focus osteosynthesis, regardless of the technique used, allows preservation of the skin, but does not allow reduction of the fracture as is obtained with open focus osteosynthesis. In this work, we report our experience with a series of 13 patients with a tibial pilon fracture treated with percutaneous screw fixation more or less pinning on demand associated with plaster cast immobilization for 3 to 4 weeks. This approach allowed us to obtain anatomical reduction of the fracture in 80% of cases, and satisfactory reduction (contact of more than 70% on either side of the fracture site as well as reconstruction of a correct tibiotalar articular surface) in 20% of cases. Thus, this approach allowed us to obtain consolidation for 12 cases of fractures in an average of 4 months with a good functional result (average AOFAS score is 87.2).

Keywords : Tibial pilon; fracture; percutaneous screw; plaster cast immobilisation