Fractures (complex): assessment and management

Recommendation ID: NG37/2
Question: Pilon fractures:- In adults with closed pilon fractures, what method of fixation provides the best clinical and cost effectiveness outcomes as assessed by function and incidence of major complications at 2 years (stratified for timing of definitive surgery early [under 36 hours] versus later [over 36 hours])?
Any explanatory notes (if applicable): Why this is important:- Pilon fractures involve a significant proportion of the weight-bearing surface of the distal tibia. The damaged joint surface is vulnerable to degeneration. Therefore, the injury can lead to long-term disability, most commonly arthritis with pain and stiffness. Surgery can improve outcomes, allowing reduction and fixation of the fracture and early movement of the ankle joint. However, it has a high incidence of serious complications, particularly related to the vulnerability of the soft tissues around the ankle. The potential for life-changing adverse consequences of both the injury and its treatment is known, but the best management strategy to minimise these consequences is unclear.

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Is this a recommendation for the use of a technology only in the context of research?	No
Is it a recommendation that suggests collection of data or the establishment of a register?	No
Last Reviewed	29/02/2016