Pilon Fracture: Causes, Diagnosis, Treatment

Pilon fracture is a fracture of the lower end of the tibia bone that forms the ankle joint by articulating with the talus. This fracture was first described by Destot in 1911. This fracture occurs when the talus bone hits the tibia bone with a force directed upwards.

This injury is seen in motor vehicle accidents and after falling from a height on your feet.

Before reading further it would first be good to know the relevant ankle anatomy. (skip this it you have already read the page)

Symptoms are similar to other ankle fractures except that there is more

painswellingblister formationreddish bluish discolouration due to leakage of blood in tissueschances of skin breakdown and infection

This fracture is a medical emergency and requires urgent treatment that includes

alignment and splintageelevation of the extremityuse of ice and anti-inflammatory medication

These measures help in reduction of pain and swelling and minimise the chances of skin breakdown.

Classification of these fractures is into three types

Type 1 fractures are usually low energy injuries in which the fracture fragments are nearly aligned and the joint surface is congruousType 2 fractures are usually moderate energy injuries in which the joint surface no longer congruousType 3 fractures are usually high energy injuries in which the joint surface is no longer congruous and the fracture may extend further upwards

Diagnosis is confirmed by x rays of the ankle joint.

CT scan may be required for a better understanding of the fracture pattern.

Treatment of pilon fracture depends upon

age and functional level of the patientpresence of osteoporosisstatus of the skin and tissues

Treatment can be operative or non-operative.

Non-operative treatment includes

plaster cast application is used in type 1 fractures and in type 2 fractures if manipulation of the fracture gives a congruous joint surfacetraction (continuous force applied along the bone) is used in patients in which the vitality of the skin is questionable and are unfit for surgery

Operative treatment includes

plate and screw fixation that is done in type 2 and 3 fractures in which the condition of the skin is goodexternal fixation with a frame applied to the bone that is done in type 2 and 3 fractures in which the condition of the skin is not good; using plate and screws in such a condition greatly increases the chances of infectionlocking plate fixation is a new method that is used in fractures occurring in osteoporotic bone

This is a x ray of a 26 year male who came with a type 1 pilon fracture, that he sustained after his motorcycle slipped. The fracture was re-aligned with manipulation and stabilized with a plaster cast.

The top photo shows the fracture immediately after injury. The middle one is a photo of a fluoroscopy screen during manipulation, that shows acceptable re-alignment of the fracture.
The third photo is of a x ray that was taken 10 days later in a plaster cast and it shows continued satisfactory alignment of the fracture. Hence this patient was managed non-operatively in a whole leg plaster cast.

Complications include

infectionmal-union or union of the fracture in a unacceptable positionnon-union that is failure of the fracture to unitearthritis of the ankle joint

How can the complications be prevented?

Complications can be prevented by alignment and fixation of the fracture as early as possible. It there is a delay of few hours in reaching the hospital then the following steps can be taken

the fracture should be splintedlimb should be elevated by placing 2 to 3 pillows below the foot and legice should be used intermittently; never use ice directly over skin, wrap it in a plastic bag

How long will it take to completely recover after a pilon fracture?

In the absence of complications the fracture unites in 2 to 3 months.

I hope the information provided was helpful. If you have any query you can ask me at the contact me page.

This page was last updated on 2nd March 2009.

Other causes of ankle pain ...

Ankle Fracture

Ankle Sprain

Ankle Arthritis

Tillaux Fracture

Ankle Dislocation

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