Classifications in Brief: Rüedi-Allgöwer Classification of Tibial Plafond Fractures
One of the first pivotal shifts in the approach to treating pilon fractures came from the proposed techniques and results published by Rüedi and Allgöwer in 1968 . They noted from previous studies that nonoperative treatment was likely to result in secondary joint displacement and worse outcomes. Rüedi and Allgöwer postulated that by adhering to strict aseptic technique and applying four operative stages, internal fixation of pilon fractures would result in the best-possible anatomic reconstruction. This staged principle was applied in a series of 84 comminuted pilon fractures in 82 patients . Rüedi and Allgöwer's first step calls for restoration of the length of the fibula to assist in fracture reduction of the tibia. They noted that 60% of all cases involved a concomitant transverse or oblique fracture of the fibula. An initial approach to the tibia was possible in the remaining 40% of cases. The second step involves anatomic restoration of the distal articular surface of the tibia. They commented on the “jigsaw puzzle” nature of severely comminuted fractures in half of all patients and recommended using the talus as a guide to reconstruct the tibia. Next, autologous bone graft can be used to fill the metaphyseal bone defect and support the articular surface to prevent collapse. Finally, buttress plate fixation can be applied to the medial side of the tibia to prevent late-onset varus deformity.
Although there are numerous modern techniques for pilon fixation, the concepts presented by Rüedi and Allgöwer still form the foundation of the surgical approach to these injuries [24, 30]. Furthermore, their contributions to the management of pilon fractures included not only surgical principles, but also the introduction of a classification system still widely used [26, 27].