Pilon Fractures
A Pilon
fracture is a specific type of break (aka fracture) of the ankle joint. It refers to a fracture of the tibia at the joint
surface (aka intra-articular). A pilon
fracture typically occurs from a high energy injury such as a fall from a
height or motor vehicle collision and often have multiple fragments of bone
called comminution. The high energy
nature as well as the involvement of the joint surface makes a pilon fracture a
more severe injury with higher complications then an ankle fracture caused by a
twisting injury.
Pilon Fracture Symptoms and Anatomy
The ankle joint is made up of three bones, the tibia (the
shin bone which supports most of the body weight), the fibula (the smaller shin
bone), and the talus. While a pilon
fracture specifically refers to the weight bearing portion of the tibia, it
often occurs together with a fracture of the fibula. The higher energy injury typically causes
more severe injury to the skin around the ankle including open fractures
(exposed bone). These fractures may also
occur in conjunction with injuries to other bones, abdomen or head.
Symptoms include:
- Pain
- Inability
to bear weight
- Deformity
of the ankle
- Skin
wounds, including exposed bone
- Swelling,
bruising, blisters of the skin due to the swelling
- Nerve
and blood vessel injury particularly in open wounds
Pilon Fracture Treatment Options
These injuries often require immediate attention at a
hospital. Emergency physicians will
assess for other injuries to the head, spine, chest and abdomen. The orthopedic surgeon will assess the leg
and ankle in addition to evaluate for other injuries to spine, pelvis or
extremities. The doctor will examine for
wounds and swelling, blood flow to the foot, as well as the sensation and
movement of your toes. Once a complete
exam is performed, the doctor will order and review x-rays and sometimes a CT
scan to plan for surgery. If the
fracture pieces are not out of alignment (nondisplaced, then nonoperative
treatment is an option. However, these injuries often require surgery to
improve alignment and provide stability for better healing.
Pilon Fracture Surgery
Surgical
treatment is often in stages due to the degree of soft tissue injury, swelling
and other associated injuries to the head, chest and abdomen.
External Fixation
An external fixator is typically the first stage in a
severe injury with a lot of swelling and soft tissue injury. The doctor will make small incisions and place
metal pins into the bone, away from the injury site. These pins are connected by bars outside of
the skin to keep the joint and fractures stable and improve overall alignment
while the swelling and soft tissue injury improves. The external fixator could be placed very
quickly in the case that other injuries to the head, chest or abdomen are more
severe and more life threatening.
Open Reduction and Internal Fixation
Once the
swelling has improved (typically in 1-2 weeks), the definitive surgery takes
place. One or more incision will be made
to restore the fracture fragments to the proper alignment and restore the joint
surface. The fracture fragments will be
held in place with metal plates and screws.
Pilon Fracture Complications
The severity of these types of fractures leads to a higher rate of complications. These include wound problems and infection. The bones may not heal, this is called nonunion, or they may heal in a bad position, this is called malunion. Long term complications include stiffness of the ankle joint and post-traumatic arthritis which may require additional surgery.