A Novel Strategy for Accurate Posterior Fragment Reduction in Posterior Pilon Fracture

Background: Reducing the posterior fragment in posterior pilon fractures presents a significant surgical challenge due to its complex anatomy and limited exposure. In recent years, the transfibular approach has gained attention for enhancing reduction accuracy and improving American Orthopaedic Foot & Ankle Society (AOFAS) scores. However, the outcomes associated with the transfibular approach remain suboptimal in many cases. This study aims to introduce a novel reduction strategy specifically targeting the posterior fragment in posterior pilon fractures and overcome the limitations observed with current methods. Methods: Clinical data were collected from 14 patients diagnosed with posterior pilon fractures who underwent surgical treatment between October 2023 and October 2024. All patients were treated using our proposed reduction strategy, which combined a transfibular approach with a posteromedial approach to improve fragment visualization and fixation. Postoperative recovery was assessed using the AOFAS score, the Visual Analog Scale (VAS) for pain, and the Kellgren–Lawrence grading system to evaluate the degree of post-traumatic osteoarthritis. Results: 11 female and 3 male were included with a mean age of 45.2 (23–67) years. The mean follow-up duration was 13.1 months (6-19 months). The mean AOFAS score was 89 (78-100). All patients reported a VAS score of ≤1 during rest and active range of motion; however, VAS scores varied during weight-bearing ambulation. Radiographic evaluation showed that all patients had a Kellgren–Lawrence grade of 0 or 1, suggesting minimal or no radiographic evidence of post-traumatic osteoarthritis. Conclusions: We propose a novel and effective for accurate reduction of the posterior fragment in posterior pilon fracture. It improves the AOFAS score and decreases posttraumatic osteoarthritis after surgery.