A 2-stage approach to treatment of tibia pilon fractures was reported in the 1990s and popularized over the ensuing decade to help avoid catastrophic soft-tissue complications experienced with one-stage open reduction and internal fixation. This approach can be expanded to the treatment of other high-energy injuries of the hind foot, with variation in external fixator application as needed. Key factors to maximize the utility and decrease complications of the external fixation stage include the following: (1) anatomic reduction of the talus under the long axis of the tibia in the coronal and sagittal planes, (2) strategic application of Schantz pins to resist deforming forces resulting from the injury, and (3) external fixation outside the zone of injury and definitive surgical treatment. This video demonstrates concepts and tactics to obtain and maintain fracture reduction with an external fixator with examples of a complex combined plafond and talus injury, as well as a more typical Orthopaedic Trauma Association/Arbeitsgemeinschaft fur Osteosynthesefragen C-type pilon fracture.
