Abstract

Pilon fracture surgery is fraught with many potential complications. Careful preoperative evaluation is required. Techniques for preoperative soft tissue management include compression dressings, stable ankle spanning external fixation, and compression foot pumps. Errors in judgment regarding the timing of surgery and over aggressive surgical exposure can lead to soft tissue complications. Postoperative wound management techniques include negative-pressure wound therapy to reduce incisional edema. Wound complications can be handled with a number of newer local pedicled rotational flaps, as well as biomaterials. These include acellular biomembranes to facilitate formation of a well-developed subcuticular tissue layer to serve as a substrate for local skin grafting. Mechanical instability occurs when the surgeon fails to neutralize deforming forces. This is accomplished by correct plate application, as well as treating areas of bone loss, that can all lead to late deformation, mechanical failure, and nonunion. This review covers crucial decision-making points regarding soft tissue and fixation strategies in an attempt to help avoid the frequency and severity of these complications.