Technical TrickThe Extensile Approach for the Operative Treatment of High-Energy Pilon Fractures: Surgical Technique and Soft-Tissue HealingAssal, Mathieu MD; Ray, Adrien MD; Stern, Richard MDAuthor Information Orthopaedic Surgery Service, University Hospital of Geneva, Geneva, Switzerland Accepted for publication December 12, 2006. No financial support of the project has occurred. The authors have received nothing of value. The devices that are subject of this article are FDA approved. Correspondence: Richard Stern, MD, Orthopaedic Surgery Service University Hospital of Geneva, 24 rue Micheli-du-Crest, 1211 Geneva, 14 Switzerland (e-mail: [email protected]). Journal of Orthopaedic Trauma: March 2007 - Volume 21 - Issue 3 - p 198-206 doi: 10.1097/BOT.0b013e3180316780 Buy Metrics Abstract Perhaps the most important advancement in the surgical treatment of high-energy pilon fractures has been the recognition of the need to delay primary surgery. However, at open reduction internal fixation an adequate incision must be made to clearly visualize the articular surface in an attempt to restore intraarticular anatomy. This article illustrates our extensile approach and its effect on soft-tissue healing. The approach allows complete access to the ankle joint to achieve reduction and fixation of the articular surface, as far medially or laterally as is necessary. In addition, it allows for easy placement of plates medially, laterally, or anteriorly. For fractures extending more proximally, plates can be placed subcutaneously from distal to proximal through the open incision. © 2007 Lippincott Williams & Wilkins, Inc.