Pilon fracture

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 Fractures

Evaluation

  • Assess distal pulse, motor, and sensation
  • Inspect skin for signs of open fracture
Pilon 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

Disposition

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

Admit for

See Also

References