Pilon Fractures<br />What are they and how are they treated?<br />By Staci Lorimer<br />
What is a Pilon Fracture?<br />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.<br />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.<br />
What is a Pilon Fracture?<br /><ul><li>Pilon fractures are most often caused by high-energy impacts, such as:
Risk Factors</li></ul> Age. 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. <br /> Male. Men are three times more likely than women to have pilon fractures<br />A pilon fracture often affects both bones of the lower leg. <br />
How Does the Patient Present?<br />Immediate and severe pain <br />Swelling <br />Bruising <br />Tender to the touch <br />Cannot put any weight on the injured foot <br />Deformity ("out of place")—your ankle looks angled or crooked <br />
How Does the Patient Present?<br /><ul><li>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.</li></ul>To fully evaluate the fracture, your doctor may recommend an x-ray (left), a CAT scan (center), or a three-dimensional CAT scan (right). <br />
Surgical Procedures<br /><ul><li>If 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.</li></li></ul><li>Surgical Procedures<br /><ul><li>Once 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. </li></li></ul><li>Outcome Study<br />Tibial Plafond Fractures <br />How Do These Ankles Function Over Time? <br />J. Lawrence Marsh, MD, Dennis P. Weigel, MD and Douglas R. Dirschl, MD <br />Background: The outcome of fractures of the tibialplafond treated with current techniques has not been reported,to our knowledge. The purpose of this study, performed at aminimum of five years after injury, was to determine the effectof these fractures on ankle function, pain, and general healthstatus and to determine which factors predict favorable andunfavorable outcomes.<br />
Outcome Study<br />Methods: Fifty-six ankles (fifty-two patients) with a tibialplafond fracture were treated with a uniform technique consistingof application of a monolateral hinged transarticular externalfixator coupled with screw fixation of the articular surface.Thirty-one patients with thirty-five involved ankles returnedbetween five and twelve years after the injury for a physicalexamination, assessment of ankle pain and function with theIowa Ankle Score and Ankle Osteoarthritis Scale.<br />
Outcome Study<br /><ul><li>Results:Arthrodesis had been performed on five of the fortyankles for which the outcome was known at a minimum of fiveyears after the injury. Other than removal of prominent screws(two patients), no other surgical procedure had been performedon any patient. The average Iowa Ankle Score was 78 points The scores on Ankle OsteoarthritisScale demonstrated a long-term negative effect of the injuryon general health and on ankle pain and function when comparedwith those parameters in age-matched controls. The degree ofosteoarthrosis was grade 0 in three ankles, grade 1 in six,grade 2 in twenty, and grade 3 in six. The majority of patientshad some limitation with regard to recreational activities,with an inability to run being the most common complaint (twenty-sevenof the thirty-one patients). Fourteen patients changed jobsbecause of the ankle injury. Fifteen ankles were rated by thepatient as excellent; ten, as good; seven, as fair; and one,as poor. Nine patients with previously recorded ankle scoreshad better scores after the longer follow-up interval. The patientsperceived that their condition had improved for an average of2.4 years after the injury.</li></li></ul><li>Conclusion<br />Conclusions: Although tibial plafond fractures have an intermediate-termnegative effect on ankle function and pain and on general health,few patients require secondary reconstructive procedures andsymptoms tend to decrease for a long time after healing.<br />