Definition
A pilon fracture is an intra-articular fracture of the distal tibial plafond, usually caused by axial loading. High-energy injuries often have severe comminution and major soft-tissue damage.
Mechanism
- high-energy axial load, such as fall from height or road traffic trauma
- lower-energy rotational injury in selected patients
Assessment
- inspect the soft tissues carefully
- document open wounds and fracture blisters
- assess neurovascular status
- assess for compartment syndrome
- look for associated fibular and other limb injuries
Imaging
- AP, lateral and mortise radiographs
- CT is important for defining articular fragments and planning fixation, usually after provisional restoration of length and alignment in severe injuries
Treatment principles
Low-energy, minimally displaced fracture
Selected injuries may be treated non-operatively with close radiographic follow-up.
High-energy fracture
A staged strategy is commonly used:
- restore length and alignment with a spanning external fixator when required
- allow soft-tissue swelling to settle
- obtain CT for definitive planning
- perform definitive fixation when the soft-tissue envelope is suitable
Goals of surgery
- restore articular congruity
- restore tibial length, alignment and rotation
- stabilise the fracture while respecting soft tissues
Complications
- wound breakdown
- infection
- non-union or malunion
- stiffness
- post-traumatic ankle arthritis
Diagram
