Pilon fracture: Difference between revisions
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==Evaluation== | ==Evaluation== | ||
[[File:Pilon fracture xray.jpg|thumb|Pilon fracture]] | |||
[[File:Pilon fracture.jpg|thumb|Pilon Fracture]] | |||
===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 | *Assess distal pulse, motor, and sensation | ||
*Inspect skin for signs of open fracture | *Inspect skin for signs of open fracture | ||
*Suspect other fracture as well, given mechanism: | *Suspect other fracture as well, given mechanism: | ||
**Lumbar spine (esp L1), calcaneus, talar dome, tibial plateau, femoral neck, acetabulum, | **Lumbar spine (esp L1), calcaneus, talar dome, tibial plateau, femoral neck, acetabulum, | ||
*Monitor for compartment syndrome | *Monitor for compartment syndrome | ||
==Management== | ==Management== | ||
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==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 04:53, 10 May 2019
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
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
- 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