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Posterior pilon fracture is a special and unique type of ankle fracture, and its injury mechanism and treatment principles are different from those of the trimalleolar fracture in the Lauge-Hansen classification, and also different from those described for the classic pilon fracture. The fractures have a low incidence and generally poor prognosis. The prevalence of posterior pilon fractures is 6.4% of all trimalleolar fractures, and 5.6% of all pilon fractures based on computed tomography images. The pathological features of posterior pilon fractures are different from those of the traditional ankle fracture and the classic pilon fracture, and it is very important to differentiate a posterior pilon fracture from the others. Because of the low incidence and high variation in fracture morphology, there is controversy over the practicable classification of posterior pilon fractures based on clinical features, such as injury mechanism, fracture classification and surgical approach. An ideal fracture classification system can reveal the injury mechanism and severity, guide the treatment, and predict prognosis. At present, no classification method is based on the injury mechanism, and none can summarize fracture morphology and guide treatment. The purpose of this study was to review the injury mechanism, clinical characteristics, classifications, treatments, and outcomes of posterior pilon fractures, to promote surgeons' understanding of posterior pilon fracture and reduce perioperative complication.
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