Early Staged Fixation of an Open Pilon Fracture After a Motor Vehicle Collision

Pilon fractures challenge reconstruction because the articular injury occurs within a thin, vulnerable soft tissue envelope, and the optimal timing of definitive fixation after an open injury remains uncertain.We describe a 56-year-old man with type 2 diabetes mellitus who sustained an open right pilon fracture with an associated distal fibular fracture in a restrained head-on motor vehicle collision.Intravenous antibiotics were given shortly after arrival, and the fracture was closed-reduced and temporarily immobilized in the trauma bay.The next day, he underwent irrigation and debridement, percutaneous lag screw fixation of a posterior component, and ankle-spanning external fixation.Four days later, definitive open reduction and internal fixation of the tibia was performed through anterolateral and posteromedial approaches, followed by frame removal; the fibula was managed non-operatively.At three weeks, the incisions showed no signs of infection, the traumatic wound had a dry eschar, and peri-incisional sensation was decreased.At eight weeks, there was still no clinical evidence of infection, and radiographs showed intact hardware and interval callus with some shortening and a slight extension deformity.This case illustrates individualized early conversion within a staged strategy in a patient at increased risk of complications, and it raises the question of fibular fixation for maintaining length.Eight-week follow-up cannot establish union, function, or an optimal interval; timing should remain guided by the wound, soft tissues, fracture pattern, and patient condition.