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Posterior Approaches for Posterior Pilon Fractures
Routine bimalleolar or trimalleolar fractures can be managed well with the patient positioned supine and with the use of traditional medial and lateral incisions. Small posterior malleolar fractures do not represent a significant articular injury but are simply the result of avulsion of the posterior inferior tibiofibular ligament (PITFL). However, a subset of posterior malleolar fractures are much larger and most likely are the result of both PITFL traction (avulsion) and direct axial loading of the talus on the posterior tibia (Figure 1). These injuries have been termed posterior pilon fractures.