A pilon fracture is a type of break of the shinbone (tibia) that happens near the ankle. Most of the time, it involves breaks in both the tibia and fibula of the lower leg. The lower ends of these bones make up part of the ankle.
The term “pilon” comes from the French word for pestle. This is an instrument used for crushing. In many pilon fractures, a high-energy impact causes the injury. Because of the high energy involved in this fracture, many people with pilon fractures have additional injuries.
Healthcare professionals classify pilon fractures according to their severity.
Pilon fractures are relatively rare, especially in children and elderly people. Pilon fractures have become more common in recent years because air bags have increased the number of people that survive high-speed car crashes.
High-energy impacts most commonly cause pilon fractures. Falls from heights, motor vehicle accidents, and skiing accidents are common causes. Usually, the force from the impact drives a bone from the foot (the talus) into the tibia. The energy from the impact fractures the tibia and usually the fibula. It often causing other injuries as well.
Pilon fractures cause a number of symptoms, like:
Your symptoms may vary according to the severity of your injury. You might also have symptoms from additional injuries.
Your healthcare provider will talk to you about your symptoms and about your medical history. Your healthcare provider will do a full physical exam to check you for other injuries. Your healthcare provider will also carefully examine your lower leg and ankle. Your healthcare provider may push on different areas to see whether they are painful to the touch, inspecting the area for swelling. Your healthcare provider will also make sure the blood supply to your foot and ankle is still intact.
Your healthcare provider will probably also order X-rays of your leg, ankle, and foot to see whether you have any broken bones. You might also need a computed tomography (CT) scan to evaluate your injury in more detail. An emergency room healthcare provider often makes your diagnosis.
Some people with pilon fractures will not need surgery. If the bones of your tibia still line up correctly, you might not need surgery. Nonsurgical treatments include:
Your healthcare provider might also recommend nonsurgical treatment for your pilon fracture if you have other medical conditions that might make surgery more of a risk.
If the bones of your pilon fracture are out of place, you will probably need surgery. Your healthcare provider might temporarily delay your surgery until your swelling has gone down. While you wait, you might need to have a splint or other type of immobilization.
During surgery, your surgeon can perform internal fixation. The purpose of internal fixation is to permanently put your bones in the correct position to help them heal. Your healthcare provider will use special plates and screws through the bone to keep the bones in the correct configuration. Depending on the extent of your injuries, your healthcare provider might do this in 2 separate surgeries.
After your leg has healed a little, your healthcare provider may prescribe a removable brace or splint, so that you can do physical therapy when you remove it. These exercises will help restore and maintain your range of motion and strength. You’ll need to use crutches or a cane for several months after your injury.
Your healthcare provider also might prescribe a medicine to prevent blood clots in your leg while you recover (a “blood thinner”).
You might have complications from your pilon fracture, such as:
Your risk of complications may vary according to your other medical conditions and the severity of your injury. For example, you are more likely to develop arthritis in your ankle joint if you had a severe pilon fracture. Following all of your healthcare provider’s instructions carefully may help reduce your risk of complications.
Call your healthcare provider if any of the following happens:
A pilon fracture is a type of break of the shinbone that happens near the ankle. Most of the time, high-impact injury breaks both bones of the lower leg.
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