Arthroscopic Fixation of Tibial Plafond Central Depression Pilon Fracture With Percutaneous Jail Screw Technique

Ankle fractures comprise up to 10% of fracture cases in adults. Ankle fractures frequently require surgical treatment to prevent posttraumatic osteoarthritis in the future. One of the most complex patterns is the pilon type of ankle fracture. It is commonly associated with high complication rates. When the foot is in a neutral position, a pure compression force leads to a central depression type of tibial plafond fracture. Traditionally, it is managed by open reduction and internal fixation, which requires large incisions and more soft-tissue dissection. The central depression is difficult to approach with traditional open surgery, especially when the anterior tibial cortex is intact. Further extension of surgical wound may be needed to tackle the distal tibial shaft fracture as well. With recent development on minimally invasive technique, this fracture can be successfully managed with an arthroscopic approach using multiple stab incisions. In this Technical Note, we present a full percutaneous approach to manage this type of injury using jail screw technique with arthroscopy.