Pilon fracture: Difference between revisions
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==Background== | ==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 | **"Pilon" is another word for pestle, a tool used to grind substance in a mortar | ||
*Also known as a tibial plafond fracture | *Also known as a tibial plafond fracture | ||
== | ==Clinical Features== | ||
* | *Ankle pain/deformity | ||
* | *Inability to bear weight | ||
*Local tenderness to palpation | |||
* | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Distal leg fractures DDX}} | {{Distal leg fractures DDX}} | ||
==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 | |||
*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== | ==Management== | ||
{{General Fracture Management}} | |||
===Specific Management=== | |||
*[[Long leg posterior splint]] | *[[Long leg posterior splint]] | ||
*Consult ortho for surgery | *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]] | |||
==See Also== | ==See Also== | ||
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*[[Ankle (Main)]] | *[[Ankle (Main)]] | ||
== | ==References== | ||
<references/> | |||
[[Category: | [[Category:Orthopedics]] | ||
Revision as of 04:59, 18 September 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
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