Evolution of Surgical Exposures for the Pilon: What has Changed over the Last 20 Years

Purpose and context: Pilon fractures typically result from traumatic incidents involving significant axial and rotational forces. The primary focus is on anatomical bone injuries and significant damage to soft tissues. The treatment has difficulties in avoiding soft tissue problems following a stage of surgery due to the complexity of surgical methods. Several surgical exposures can be used for the distal tibia and the ankle joint visualization, including anteromedial, anterolateral, medial, posteromedial and its modification, and posterolateral approaches. Each approach has individual advantages and constraints. The choice between single or combination approaches depends on factors such as the characteristics of the fracture, the planned reduction and fixation, and the state of soft tissue management. This review article presents an analysis of the development of surgical exposures, including their indications, benefits, drawbacks, and techniques. There is a current trend indicating that wound problems are not associated with recent surgical incisions published in the past decade. This is attributed to the careful treatment of soft tissues and preservation of angiosomes.