Role of Arthroscopy in Pilon Fractures: How and When do I do It?

Pilon fracture is usually a high-energy trauma involving the soft tissue and bone. Operative treatment of complex intraarticular fractures of the distal tibia was historically fraught with difficulty and high complications rates. The importance of adequate soft tissue management when dealing with these high-energy injuries has became well-recognized as a crucial factor in determining the success of such surgeries. Arthroscopic assisted reduction of the fracture is attractive as it is a minimally invasive approach with less surgical trauma to the soft tissue and provides direct visualization of the articular surfaces, assessment of reduction of the articular fragments and detection of associated chondral injury. However, it is also time-consuming, technically demanding and requires a long learning curve. Its role in the management of pilon fractures appears limited and requires further study.