DOI: https://doi.org/10.36347/sasjs.2026.v12i08.011

Pages: 702-709

Background: Tibial pilon fractures are articular injuries of the distal tibia whose management must balance restoration of articular congruity, mechanical stability, and preservation of the soft-tissue envelope. We report an AO/OTA 43-C1 fracture treated with targeted fixation of the main fragments using five cancellous screws through two minimally invasive approaches. Case presentation: An otherwise healthy 18-year-old man sustained a high-energy motorcycle–car collision. On admission, his Glasgow Coma Scale score was 15/15. Examination showed complete functional impairment of the right lower limb, ankle deformity, and an approximately 1-cm superficial medial wound that did not communicate with the fracture site. Distal pulses were palpable. Radiographs and computed tomography demonstrated an AO/OTA 43-C1 fracture of the right tibial pilon with complete separation of the distal epiphyseal block, a large anteromedial fragment incorporating the medial malleolus, and an anterolateral Chaput fragment; there was no metaphyseal comminution, and the fibula was intact. On hospital day 1, after wound review, the fracture was reduced and fixed with two medial screws, two anteroposterior screws, and one independent screw for the Chaput fragment. The postoperative course was uncomplicated. At 3.5 months, bone union was satisfactory, with disappearance of the fracture lines on follow-up radiographs. Functional recovery was excellent; walking was pain-free, with only a mild reduction in plantar flexion compared with the uninjured side. Conclusion: In a selected patient with an AO/OTA 43-C1 fracture composed of clearly defined major fragments and a soft-tissue envelope suitable for early fixation, fragment-specific screw fixation through two limited approaches may achieve satisfactory reduction while minimising additional soft-tissue injury. Longer follow-up remains necessary to assess the definitive articular outcome.