Historically high complication rates encouraged the evolution of pilon fracture management. This article reviews these complex fractures, offering insight into the evolution of treatment with a glimpse into future management techniques, while superimposing our experience with included retrospective analysis of 41 pilon fractures treated at our institution by a single surgeon (T.M.C.) spanning 60 months. With improved understanding and advancing technology, multiple literature-supported strategies are available for the management of these limb-threatening traumas. Intriguing strategies needing further investigation may one day shift the paradigm
as for now, the foundational principles of pilon fracture management continue to anchor the treatment strategy.