Pilon Fractures of the Ankle: Overview

Pilon Fractures of the Ankle: Overview

This video will provide an overview of pilon fractures. Pilon fractures are breaks in the end of the tibia, or shinbone, near the ankle. Pilon is the French word for pestle and describes the crushing force that occurs with this injury across the weight-bearing end of the bone. Pilon fractures can be characteristically difficult to manage. However, with a proper understanding of their unique factors, they can be successfully managed.

The challenging characteristics include the following:

1. These fractures are intra-articular, meaning they extend into the ankle joint. Given this, patients with these fractures are at particular risk for developing ankle arthritis.

2. These fractures are often comminuted, which means that the bone has broken into multiple, small, displaced fragments. This is due to the strong force applied to the flat surface of the base of the tibia at the time of injury.

3. Up to 50% of these fractures may be open, meaning the bony breaks extend through the skin. An open fracture increases risk for infection, difficulty healing, and wound complications.

4. These fractures may be associated with other injuries. Given the high-force nature of these injuries, they may be accompanied by fractures to the nearby fibula bone or other traumatic injuries.

5. Lastly, these fractures are often associated with soft-tissue damage. Patients may have severe swelling and blisters around the ankle. Because of this, careful consideration will be made to the timing and type of treatment offered.

Pilon fractures are uncommon and account for less than 10% of tibia fractures and less than 1% of fractures to the legs and feet. These fractures slightly favor a predominance of males over females, and are mostly caused by high-energy trauma, such as motor vehicle accidents or falls from a height. In this setting, force is driven from the talus bone into the flat portion at the base of the tibia, called the plafond, the French word for ceiling.

Patients with a history of high-energy trauma with pain around the ankle should be evaluated for these fractures. In addition to pain, swelling, deformity, and an inability to walk will be seen. Bruising or blistering may also be noted.

Often, these injuries are initially diagnosed in an emergency room setting and require admission to the hospital for more intensive management.

In addition to the soft-tissue and bony abnormalities, a health care provider will closely evaluate the ankle for any signs of nerve or blood vessel compromise.

X-rays will be completed to make the initial diagnosis. A CT scan is almost always indicated to look closely at the fracture patterns and assist with treatment planning. Once a thorough understanding of the diagnosis is completed, a prompt transition to treatment recommendations will be made.