A 22-year-old male presented to the emergency department with left ankle pain after a skiing accident where he landed on a rock twisting his ankle. On examination, he had tenderness to palpation over the left ankle with diffuse edema and abrasions, but intact neurovascular status. Imaging revealed a pilon fracture of the left ankle requiring immediate orthopedic surgery consultation and splinting.

2.  Patient is a 22 yo WM
 Vitals: T: 97.8, HR: 78, RR: 16,
that presents to ED with
left ankle pain after a

skiing accident. Pt was
snow skiing and landed 

on a rock after a jump
twisting his left ankle. 
He has not been able to
walk on it since. Pt
denies any other injuries. 
BP: 118/60
Gen: WD, WN, WM in NAD
CV: RRR
Pulm: CTA B
MSK: ttp over left ankle with
diffuse edema and abrasions.
2+ pulses. Good cap refill
Neuro: motor/sensory intact.
Pain with strength testing and
passive ROM.

4.  A pilon frcture, also known as a tibial plafond fracture,
and include a distal tibial metaphyseal fracture with
fracture of medial malleolus, anterior margin of tibia,
and transverse fx of posterior tibial surface.

5.  Evaluate for neurovascular status
 Reduce if necessary
 Splint in posterior leg with stirrups
 Immediate orthopedic surgery consult
 Appropriate pain management

6.  Pilon fractures are high-energy ankle fractures
 Males 3x more likely than females
 25%-50% of patients have additional injuries
 Seen with falls from a height, MVC/MCC, skiing
 Type classificiation from I – III depend on the amount
of articular comminution
 CT scans are usually required to determine the plan for
surgical fixation
 Associated with fibular fractures in the majority of
cases

7. Type III Pilon fracture
After repair of Pilon Fracture with
associated fibular fracture

8.  http://www.fighttimes.com/magazine/magazine.asp?a
rticle=481
 Tintinalli, Judith E., Gabor D. Kelen, and J. Stephan.
Stapczynski. Emergency Medicine: A Comprehensive
Study Guide. New York: McGraw-Hill, Medical Pub.
Division, 2004.
 Wheeles, Clifford. "Wheelesonline.com."
Wheelesonline.com. Duke Orthopedics. Web. 04 June
2012. <http://www.wheelesonline.com/ortho>.