Pilon Fractures of the Ankle: Treatment Options

Pilon Fractures of the Ankle: Treatment Options

This video will provide an overview of the treatment options for pilon fractures.

Pilon fractures involve the distal, or far end of the tibia. The tibia is 1 of 2 bones in the lower leg. The other bone is the fibula, often broken in these injuries.

Pilon fractures are associated with multiple characteristics, including extension of the fracture into the ankle joint and multiple, small fragments of broken bone. They also often have significant soft-tissue swelling and blistering.

The goals of treatment are to reduce long-term complications such as ankle arthritis, incomplete healing, infection, and delayed wound healing.

While surgical treatment for pilon fractures is typically needed, there are circumstances where no surgery is needed, such as advanced age, medical issues that prevent safe surgical repair, or fracture type, such as fractures that have no displacement.

Treatment without surgery consists of setting the bones in proper position which is done under light sedation.

Once an acceptable bony position is achieved, the leg will be placed into a cast for several weeks. Patients will be non-weight-bearing for upwards of 12 weeks depending on the healing seen on x-rays. Physical therapy will be advised to assist with range of motion, strengthening, and walking when allowable.

For most pilon fractures, surgical treatment is warranted to restore the alignment of the ankle.

In the past, surgery was done in 1 procedure. However, higher complication rates were seen with infection and healing. While there are still circumstances in which 1 procedure is warranted, today, pilon fractures are commonly treated in a two-staged approach. Surgery with this approach now involves the use of temporary external hardware, known as an external fixator. This consists of pins in the bone that connect to bars on the outside of the skin. This allows for the bones to be quickly stabilized and aligned, so the soft tissue injuries can heal. The temporary hardware is applied quickly after the injury to stabilize the bones.

If a fracture has come through the skin, surgery to clean out the fracture site will be warranted. This may be done with the placement of the external fixator. Intravenous antibiotics will be warranted to minimize infection risk.

If an external fixator is used, patients will be non-weight-bearing and encouraged to elevate the extremity to help with swelling. The pin sites of the external fixator may require cleaning which will be determined by the surgical team.

The second stage of the procedure will include removal of the external fixator and placement of the internal hardware, along with aligning the bone fragments. This will be completed when the surgeon feels the soft tissue has healed enough. While timing may differ, this is usually 10-14 days after the injury.

Internal hardware will vary depending on the type of fracture. Hardware to fuse the ankle joint is occasionally required given the severity of the injury.

After surgery, a temporary splint may be placed. Patients will remain non-weight-bearing until sufficient healing is seen on x-rays. Patients will be followed closely over several months to ensure full healing of the bone and adequate return of motion to the ankle. Physical therapy will be ordered to help patients with range of motion, strength, and return to activities.