Pilon FracturesWhat are they and how are they treated?

By Staci Lorimer

What is a Pilon Fracture?Pilon is a French word for pestle, an

instrument used for crushing or pounding. In many pilon fractures, the bones of the ankle joint are crushed due to the high-energy impact causing the injury. Pilon fractures may be considered high-energy ankle fractures.

Pilon fractures affect the bottom of the shinbone (tibia) at the ankle joint. In most cases, both bones in the lower leg, the tibia and fibula, are broken near the ankle.

What is a Pilon Fracture? Pilon fractures are most often caused

by high-energy impacts, such as:

Fall from height Motor vehicle/motorcycle collisions Skiing

Risk FactorsAge. The average age of someone with a pilon fracture is 35 to 40 years old. Pilon fractures are rare in children and elderly people. However, as our population ages, seniors will account for a larger amount of these fractures. Male. Men are three times more likely than women to have pilon fractures A pilon fracture often

affects both bones of the lower leg.

How Does the Patient Present?Immediate and severe pain Swelling Bruising Tender to the touch Cannot put any weight on the injured foot Deformity ("out of place")—your ankle looks

angled or crooked

How Does the Patient Present?After discussing the symptoms

and medical history, the doctor will examine the lower leg and ankle. This will include looking at the ankle and pushing on different areas to see if it hurts.

The doctor will check for sensation and look for a pulse to make sure there is blood supply to the foot and ankle. He or she will also check for swelling, which may determine if and when surgery can be done.

To fully evaluate the fracture, your doctor may recommend an x-ray (left), a CAT scan (center), or a three-dimensional CAT scan (right).

Surgical ProceduresIf the pilon fracture is out of

place, the most common way to treat it is with surgery. During surgery, metal implants — such as plates and screws — are used to hold things in place until the bone is fully healed.

If there is significant swelling or blisters, the doctor will delay surgery until the swelling goes down. Surgery that is performed too early increases the risk for infection or problems with the incision.

Surgical ProceduresOnce the swelling and

blisters go away, the doctor can perform surgery to fix the tibia bone with plates and screws

In this case the patient may be treated with an external fixator only or with an external fixator and some screws.

Outcome StudyTibial Plafond Fractures How Do These Ankles Function Over Time? J. Lawrence Marsh, MD, Dennis P. Weigel, MD and

Douglas R. Dirschl, MD

Background: The outcome of fractures of the tibial plafond treated with current techniques has not been reported, to our knowledge. The purpose of this study, performed at a

minimum of five years after injury, was to determine the effect of these fractures on ankle function, pain, and general health status and to determine which factors predict favorable and unfavorable outcomes.

Outcome StudyMethods: Fifty-six ankles (fifty-two patients)

with a tibial plafond fracture were treated with a uniform technique consisting of application of a monolateral hinged transarticular external fixator coupled with screw fixation of the articular surface. Thirty-one patients with thirty-five involved ankles returned between five and twelve years after the injury for a physical examination, assessment of ankle pain and function with the Iowa Ankle Score and Ankle Osteoarthritis Scale.

Outcome Study Results: Arthrodesis had been performed on five of the forty ankles for

which the outcome was known at a minimum of five years after the injury. Other than removal of prominent screws (two patients), no other surgical procedure had been performed on any patient. The average Iowa Ankle Score was 78 points The scores on Ankle Osteoarthritis

Scale demonstrated a long-term negative effect of the injury on general health and on ankle pain and function when compared with those parameters in age-matched controls. The degree of osteoarthrosis was grade 0 in three ankles, grade 1 in six, grade 2 in twenty, and grade 3 in six. The majority of patients had some limitation with regard to recreational activities, with an inability to run being the most common complaint (twenty-seven of the thirty-one patients). Fourteen patients changed jobs because of the ankle injury. Fifteen ankles were rated by the patient as excellent; ten, as good; seven, as fair; and one, as poor. Nine patients with previously recorded ankle scores had better scores after the longer follow-up interval. The patients perceived that their condition had improved for an average of 2.4 years after the injury.

Conclusion

Conclusions: Although tibial plafond fractures have an intermediate-term negative effect on ankle function and pain and on general health, few patients require secondary reconstructive procedures and

symptoms tend to decrease for a long time after healing.

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