Pilon fracture

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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 Fractures

Evaluation

Pilon fracture
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

General Fracture Management

Specific Management

Disposition

  • If stabilized without evidence of significant articular displacement, can be managed as outpatient after consultation with Ortho

Admit for

See Also

References