Pilon Fractures

Objectives: The purpose of this study is to synthesize Level IV or higher evidence related to tibial plafond (pilon) fractures and to translate this evidence into a standardized, evidence-based clinical note template designed to support consistent evaluation, risk stratification, and treatment planning in orthopedic trauma practice. Design: Structured literature review with development of an accompanying evidence-based clinical note template. Main Outcome Measurements: Fracture classification, diagnostic evaluation, treatment strategies, complication rates, functional outcomes, and evidence-supported elements of clinical documentation relevant to pilon fractures. Results: A structured review of the orthopedic literature identified tibial plafond fractures as complex, high-energy injuries frequently associated with articular comminution, soft-tissue compromise, and concomitant musculoskeletal injuries. The AO/OTA classification system remains the most widely utilized framework for fracture characterization. Evidence supports a range of management strategies, including nonoperative treatment, staged open reduction and internal fixation, circular frame fixation, intramedullary nailing with limited internal fixation, primary hindfoot arthrodesis, and, in rare cases, amputation. High rates of complications persist across treatment modalities, including infection, nonunion, post-traumatic arthritis, and long-term functional impairment. These findings informed the development of a comprehensive, structured clinical note template that incorporates key history, physical examination, imaging, risk factors, and management considerations, supported by current evidence. Conclusions: Tibial plafond fractures remain among the most challenging injuries in orthopedic trauma, with substantial morbidity despite advances in surgical technique. An evidence-based, standardized documentation approach may improve clinical consistency, facilitate multidisciplinary care, and support evidence-informed decision-making. The accompanying note template provides a practical tool for integrating current evidence into daily clinical practice. Level of Evidence: Level IV; Structured Review of Level IV or Higher Evidence Key Words: Pilon fracture, tibial plafond, evidence-based documentation, clinical note template, orthopedic trauma, fracture management