Pilon tibial fractures are intra-articular fractures of the distal tibial metaphysis, typically resulting from high-energy axial trauma. Accurate classification using AO/OTA type 43-C and advanced imaging, including CT with 3D reconstruction, is essential for preoperative planning. Initial management of displaced fractures includes prompt reduction and temporary immobilization, often with a spanning external fixator. Definitive treatment follows a staged protocol based on soft tissue status and involves open reduction and internal fixation via approach-specific surgical access. Conservative management is reserved for stable, non-displaced fractures. Anatomical reduction is critical for favorable long-term outcomes. Postoperative care includes early physiotherapy, individualized weight-bearing, and close radiological monitoring.
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