Pilon fracture: Difference between revisions
No edit summary |
|||
| Line 32: | Line 32: | ||
==Disposition== | ==Disposition== | ||
*If stabilized without evidence of significant articular displacement, can be managed as outpatient after consultation with Ortho | *If stabilized without evidence of significant articular displacement, can be managed as outpatient after consultation with Ortho | ||
* | ===Admit for=== | ||
*[[Open fracture]] | |||
*Signs of neurovascular compromise | |||
*Concern for [[compartment syndrome]] | |||
==See Also== | ==See Also== | ||
Revision as of 17:45, 18 March 2018
Background
- High energy axial loading injury that drives tibial plafond (French for ceiling) into talar dome
- Motor vehicle accidents, falls from height
- "Pilon" is another word for pestle, a tool used to grind substance in a mortar
- Also known as a tibial plafond fracture
Clinical Features
- Ankle pain/deformity
- Inability to bear weight
- Local tenderness to palpation
Differential Diagnosis
Distal Leg Fracture Types
- Tibial plateau fracture
- Tibial shaft fracture
- Pilon fracture
- Maisonneuve fracture
- Tibia fracture (peds)
- Ankle fracture
- Foot and toe fractures
Evaluation
- Assess distal pulse, motor, and sensation
- Inspect skin for signs of open fracture
- Suspect other fracture as well, given mechanism:
- Lumbar spine (esp L1), calcaneus, talar dome, tibial plateau, femoral neck, acetabulum,
- Monitor for compartment syndrome
Imaging
- Plain radiographs
- AP, Lateral, and Mortise views of ankle
- CT often necessary to reveal amount of articular surface displacement/develop treatment plan
Management
- Long leg posterior splint
- Consult ortho for surgery
Disposition
- If stabilized without evidence of significant articular displacement, can be managed as outpatient after consultation with Ortho
Admit for
- Open fracture
- Signs of neurovascular compromise
- Concern for compartment syndrome