This study analyzes 126 consecutive pilon fractures using CT and plain radiography to define the anatomy of articular fracture patterns. The authors identify two fracture families (sagittal and coronal), ten fracture subtypes, and six distinct articular fragments. The goal is to create a reproducible, anatomy-based classification that guides surgical planning.
Before this classification, the Rüedi-Allgöwer system assumed a coronal fracture line was the defining feature of all pilon fractures. That assumption is wrong in one-third of cases.
When you get the CT on a pilon fracture, identify the fracture family first. Sagittal family fractures need coronally directed fixation screws — an anterior plate alone will cross the fracture line in over half of coronal-family cases (55% in this series).
Always look for functional diastasis. It occurs in 44% of pilon fractures and causes the same mortise widening as a ligamentous syndesmotic injury, but it won't be visible on stress views — only on CT showing displaced anterolateral and posterolateral fragments.
If the fibula is intact on your pilon fracture radiograph, actively look for lateral-disruption pattern on CT. These patients are 8 times more likely to have talofibular relationship disruption, and failing to restore it leads to predictable post-traumatic arthritis.
This study analyzes 126 consecutive pilon fractures using CT and plain radiography to define the anatomy of articular fracture patterns. The authors identify two fracture families (sagittal and coronal), ten fracture subtypes, and six distinct articular fragments. The goal is to create a reproducible, anatomy-based classification that guides surgical planning.
Before this classification, the Rüedi-Allgöwer system assumed a coronal fracture line was the defining feature of all pilon fractures. That assumption is wrong in one-third of cases.
When you get the CT on a pilon fracture, identify the fracture family first. Sagittal family fractures need coronally directed fixation screws — an anterior plate alone will cross the fracture line in over half of coronal-family cases (55% in this series).
Always look for functional diastasis. It occurs in 44% of pilon fractures and causes the same mortise widening as a ligamentous syndesmotic injury, but it won't be visible on stress views — only on CT showing displaced anterolateral and posterolateral fragments.
If the fibula is intact on your pilon fracture radiograph, actively look for lateral-disruption pattern on CT. These patients are 8 times more likely to have talofibular relationship disruption, and failing to restore it leads to predictable post-traumatic arthritis.