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Pilon fractures, or distal tibial fractures, are difficult injuries to treat, not only because of their propensity to sustain highly articulated fractures, but also because of the delicacy of the traumatized soft tissues (Johnson). Oftentimes the fracture is too comminuted to repair with open reduction and internal fixation alone (See Figure 1). The current practice of treating highly comminuted tibial fractures involves placing the patient in an external fixator which allows isolation of the tibio-talar joint so that the soft tissues can heal. After sufficient healing time the internal fixation and reduction is performed. Although this method is an improvement from how pilon fractures used to be treated in the past, the injuries are still subject to a high rate of delayed union and can develop post-operative wound complications, post-traumatic arthritis, and require multiple unplanned additional surgeries. This is why it is reasonable to suggest that primary arthrodesis of the tibio-talar joint through a postero-lateral approach could provide more long-term stability to the ankle joint while allowing the patient to have a “one and done” surgery that would help to prevent additional unplanned surgeries (Johnson).

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