RESUMO
RATIONALE: Central collapsed fracture blocks traditionally require either an anteromedial or anterolateral approach for reduction. However, existing techniques face challenges such as soft tissue damage and compromised tibial strength, especially in pilon fractures with central articular surface collapse and an intact anterior cortex, as classified under 43B2.3 in the 2018 Orthopaedic Trauma Association/Association for the Study of Internal Fixation Fracture and Dislocation Classification Compendium. PATIENT CONCERNS: We address the management of pilon fractures with central articular surface collapse, focusing on 2 cases where conventional reduction techniques posed a risk to soft tissues and tibial integrity. DIAGNOSES: The patients presented with pilon fractures characterized by a central articular surface collapse and an intact anterior cortex, aligning with the 43B2.3 classification. INTERVENTIONS: A novel approach was employed, utilizing posterior tibial fenestration and indirect reduction with compression techniques. This method leveraged the talus as a template for precise articular surface realignment. OUTCOMES: Both cases demonstrated excellent reduction of the distal tibial articular surface and achieved favorable functional recovery of the ankle, evidenced by high American Orthopedic Foot and Ankle Society Ankle Hindfoot Scale scores during the 3-year follow-up. LESSONS: The posterior tibial fenestration technique offers significant advantages for distal tibial pilon fracture reduction. It allows for precise articular realignment, facilitates bone grafting, and minimizes soft tissue and cortical bone disruption. This method is particularly effective for pilon fractures with an intact anterolateral cortex and central articular collapse, providing a valuable surgical alternative.