Pilon fracture: Difference between revisions
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==Background== | ==Background== | ||
*Fracture of the distal end of the tibia aka tibial plafond (French for ceiling) | *Fracture of the distal end of the tibia aka tibial plafond (French for ceiling) after the talar dome is driven into it | ||
**Typically due to high energy axial loading injuries (motor vehicle accident, fall from height) | **Typically due to high energy axial loading injuries (motor vehicle accident, fall from height) | ||
*Also known as a tibial plafond fracture | *Also known as a tibial plafond fracture | ||
*Fairly common; account for 5-10% of all tibial fractures | *Fairly common; account for 5-10% of all tibial fractures | ||
*Average age of occurrence is 35-45 years old; males > females | |||
==Clinical Features== | ==Clinical Features== | ||
Latest revision as of 15:14, 30 April 2022
Background
- Fracture of the distal end of the tibia aka tibial plafond (French for ceiling) after the talar dome is driven into it
- Typically due to high energy axial loading injuries (motor vehicle accident, fall from height)
- Also known as a tibial plafond fracture
- Fairly common; account for 5-10% of all tibial fractures
- Average age of occurrence is 35-45 years old; males > females
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
Work-Up
- Plain radiographs
- AP, Lateral, and Mortise views of ankle
- CT often necessary to reveal amount of articular surface displacement/develop treatment plan
Diagnosis
- 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
Management
General Fracture Management
- Acute pain management
- Open fractures require immediate IV antibiotics and urgent surgical washout
- Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
- Consider risk for compartment syndrome
Specific 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