Fig. 1

Schematic illustration of the surgical procedure. a Rüedi-Allgöwer III or AO/OTA type C3 pilon fractures are severely comminuted fractures with impaction of the distal tibia. b A large autologous ilium with periosteum is harvested from the iliac crest. c A clear view of the entire plafond and talus is obtained after distraction of the ankle joint with the tensor and removing the fracture fragment. d The concave side of ilium with periosteum is implanted directly into the residual subchondral bone using a k-wire, guided by the articular surface of the talus as a template. Cancellous bone from the graft is used to fill the bone defect following reduction of the articular segment. e The reconstructed tibiotalar joint and plafond are fixed by anatomically locked plates