Tibial pilon fractures remain a challenge for surgeons. The majority of these fractures are treated with anterior approaches. Select complex fractures require (typically additional) posterior approaches to obtain appropriate reduction and stabilization of the articular surface. Posterior approaches may be undertaken with the patient in the prone or semilateral position. The semilateral position may allow for simultaneous treatment and easy adjustment of reduction or fixation without repositioning the patient. The posterolateral approach has been commonly used by surgeons, often in conjunction with fixation of the fibula. Posteromedial approaches have been used less frequently but appear to offer significant versatility and greater access to more of the posterior column than posterolateral approaches.
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