{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T23:55:38Z","timestamp":1790898938537,"version":"4.1.0"},"reference-count":51,"publisher":"Georg Thieme Verlag KG","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Z Orthop Unfall"],"abstract":"<jats:title>Zusammenfassung<\/jats:title>\n                  <jats:p>Pilonfrakturen stellen als intraartikul\u00e4re Frakturen der distalen Tibia mit Beteiligung des oberen Sprunggelenks eine der anspruchsvollsten Verletzungen in der Unfallchirurgie dar. Diese \u00dcbersichtsarbeit analysiert aktuelle Therapiekonzepte und deren Ergebnisse basierend auf einem narrativen Review.<\/jats:p>\n                  <jats:p>Pilonfrakturen umfassen 3\u201310% aller Tibiafrakturen und entstehen typischerweise durch axiale Stauchungsmechanismen bei Hochenergie-Traumata oder Torsionskr\u00e4fte bei Niedrigenergie-Verletzungen. Die komplexe Anatomie des tibialen Plafonds mit geringer Gef\u00e4\u00dfversorgung und d\u00fcnner Weichteildeckung erschwert die Behandlung erheblich. Etablierte Klassifikationssysteme wie die R\u00fcedi-Allg\u00f6wer- oder AO-Klassifikation erm\u00f6glichen eine systematische Frakturanalyse, w\u00e4hrend die 4-S\u00e4ulen-Klassifikation nach Tang eine anatomisch orientierte Zugangsplanung unterst\u00fctzt. Die operative Versorgung folgt oftmals einem mehrzeitigen Konzept mit initialer Fixateur-externe-Stabilisierung und definitiver Rekonstruktion nach Weichteilkonsolidierung. Multiple operative Zug\u00e4nge entsprechend der 4-S\u00e4ulen-Anatomie erm\u00f6glichen eine gezielte Fragmentstabilisierung, wobei winkelstabile Plattenosteosynthesen das Standardverfahren darstellen. Die intraoperative 3D-Bildgebung hat sich als unverzichtbar f\u00fcr die Beurteilung der Gelenkkongruenz etabliert. Trotz technischer Fortschritte bleiben die Komplikationsraten mit bis zu 50% hoch, wobei Wundheilungsst\u00f6rungen, Infektionen und posttraumatische Arthrosen dominieren. Das funktionelle Outcome zeigt erhebliche Einschr\u00e4nkungen mit AOFAS-Scores zwischen 50\u201382 Punkten je nach Frakturtyp und Behandlungsverfahren. Die berufliche Wiedereingliederung ist mit 57% dramatisch eingeschr\u00e4nkt. Insbesondere k\u00f6rperlich t\u00e4tige Personen k\u00f6nnen oft nur mit deutlich reduzierter Belastbarkeit und Funktion wiedereingegliedert werden. Komplexe AO-Typ-C-Frakturen entwickeln in \u00fcber 50% eine posttraumatische Arthrose mit entsprechenden Langzeitfolgen. Pilonfrakturen erfordern eine individualisierte, mehrdisziplin\u00e4re Behandlungsstrategie mit realistischer Prognosekommunikation bez\u00fcglich der zu erwartenden funktionellen Einschr\u00e4nkungen und beruflichen Konsequenzen.<\/jats:p>","DOI":"10.1055\/a-2950-5752","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T23:33:50Z","timestamp":1790897630000},"source":"Crossref","is-referenced-by-count":0,"title":["Pilon tibiale Frakturen \u2013 was k\u00f6nnen wir erreichen?"],"prefix":"10.1055","author":[{"given":"Robin","family":"Dreisbach","sequence":"additional","affiliation":[{"name":"BG Unfallklinik Murnau, BY, Germany","place":["Murnau am Staffelsee"],"department":["Allgemeine und Traumachirurgie"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Gabel","sequence":"additional","affiliation":[{"name":"BG Unfallklinik Murnau, BY, Germany","place":["Murnau am Staffelsee"],"department":["Fu\u00df- und Sprunggelenkchirurgie"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabian","family":"Stuby","sequence":"additional","affiliation":[{"name":"Knappschaft Kliniken Universit\u00e4tsklinikum Bochum, NRW, Germany","place":["Bochum"],"department":["Klinik f\u00fcr Unfallchirurgie & Orthop\u00e4die"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3192-2097","authenticated-orcid":false,"given":"Alexander","family":"Trulson","sequence":"additional","affiliation":[{"name":"BG Unfallklinik Murnau, BY, Germany","place":["Murnau"],"department":["Klinik f\u00fcr Unfallchirurgie und Orthop\u00e4die"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,10,1]]},"reference":[{"key":"ref1","volume-title":"Pilon Fracture","author":"T D 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