Pilon Fracture: Causes, Diagnosis and 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
- blister formation
- reddish bluish discolouration due to leakage of blood in tissues
- chances of skin breakdown and infection
This fracture is a medical emergency and requires urgent treatment that includes
- alignment and splintage
- elevation of the extremity
- use 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 congruous
- Type 2 fractures are usually moderate energy injuries in which the joint surface no longer congruous
- Type 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 patient
- presence of osteoporosis
- status 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 surface
- traction (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 good
- external 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 infection
- locking 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.
- mal-union or union of the fracture in a unacceptable position
- non-union that is failure of the fracture to unite
- arthritis of the ankle joint
Frequently Asked Questions
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 splinted
- limb should be elevated by placing 2 to 3 pillows below the foot and leg
- ice 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.
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