Intra-articular Osteotomy for Correction of Malunions and Nonunions of the Tibial Pilon Stefan Rammelt, MD, PhD*, Hans Zwipp, MD, PhD INTRODUCTION Fractures of the tibial pilon are severe injuries with complex fracture patterns and sig- nificant associated articular cartilage and soft tissue damage. The treatment of pilon fractures is challenging, and functional deficits are likely to remain even with perfect anatomic reduction. 1,2 Most pilon fractures result from high-energy injuries with axial loading like motor vehicle accidents and fall form a height typically involving some degree of The authors have nothing to disclose. Foot and Ankle Section, University Center for Orthopaedics & Traumatology, University Hospi- tal Carl Gustav Carus at the TU Dresden, Fetscherstrasse 74, Dresden 01307, Germany * Corresponding author. E-mail address: strammelt@hotmail.com KEYWORDS  Tibial pilon  Fracture  Malunion  Nonunion  Correction  Osteotomy  Intra-articular  Supramalleolar KEY POINTS  Malunions after tibial pilon fractures lead to painful malfunction of the ankle joint and rapidly progress to posttraumatic arthritis.  Nonunions may result from faulty operative technique or focal necrosis at the distal tibial metaphysis.  Most malunions and nonunions of the tibial pilon can be salvaged by corrective ankle fusion.  Joint-preserving corrective osteotomies may be pursued in selected active, compliant pa- tients with good bone stock and cartilage quality at the time of presentation.  Both intra-articular and supramalleolar deformities have to be corrected in the same setting. Foot Ankle Clin N Am 21 (2016) 63–76 http://dx.doi.org/10.1016/j.fcl.2015.09.008 foot.theclinics.com 1083-7515/16/$ – see front matter Ó 2016 Elsevier Inc. All rights reserved.