• Daiqing Wei, Yangbo Xu, Feifan Xiang, and Junwu Ye.
• Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University.
• Medicine (Baltimore). 2021 Feb 19; 100 (7): e24791e24791.

RationaleDespite significant advances in surgical techniques and implants, the clinical outcome of high-energy pilon fractures remains unsatisfactory, which continues to represent numerous challenges for orthopedic trauma surgeons.Patient ConcernsA 62-year-old man injured his right ankle after falling from a 3 m high place. There were no open wounds or other complications.DiagnosesAccording to the X-ray and CT scans, the patient was diagnosed with pilon fracture (type AO-43-C2) and lateral malleolus fracture of the right limb.InterventionsThe patient was initially treated with calcaneal traction upon admission to a primary hospital. Five days after the injury, the patient underwent open reduction and internal fixation (ORIF) of the fracture and vacuum sealing drainage (VSD) for wound closure.OutcomesThe patient presented to our hospital on the 9th day after the first ORIF operation because of critical ischemia of the affected foot and distal lower leg. Blood circulation did not improve after a series of salvage treatments, and below-knee amputation was ultimately performed.LessonsThis is a rare case of complete ischemic necrosis following ORIF surgery of a closed pilon fracture due to iatrogenic damage. Standardized treatment that strictly follows the guidelines, instructions, or expert consensus should be promoted in this kind of complicated pilon fracture.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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