3. What is a Pilon Fracture?
Pilon is a French word for pestle, an instrument used
for crushing or pounding. In many pilon fractures, the
bones of the ankle joint are crushed due to the high-
energy impact causing the injury. Pilon fractures may
be considered high-energy ankle fractures.
Pilon fractures affect the bottom of the shinbone
(tibia) at the ankle joint. In most cases, both bones in
the lower leg, the tibia and fibula, are broken near the
ankle.
4. What is a Pilon Fracture?
Pilon fractures are most often caused by
high-energy impacts, such as:
Fall from height
Motor vehicle/motorcycle collisions
Skiing
Risk Factors
Age. The average age of someone with a
pilon fracture is 35 to 40 years old. Pilon
fractures are rare in children and elderly
people. However, as our population ages,
seniors will account for a larger amount of
these fractures.
Male. Men are three times more likely
than women to have pilon fractures A pilon fracture often affects
both bones of the lower leg.
6. How Does the Patient Present?
Immediate and severe pain
Swelling
Bruising
Tender to the touch
Cannot put any weight on the injured foot
Deformity ("out of place")—your ankle looks angled or
crooked
9. The AO/OTA classification system provides a comprehensive
description of distal tibial fractures.
Type A fractures are extraarticular distal tibial
fractures, which are subdivided into groups A1,
A2, and A3, based on the amount of
metaphyseal comminution.
Type B fractures are partial articular fractures
in which a portion of the articular surface
remains in continuity with the shaft; these are
subdivided into groups B1, B2, and B3, based
on the amount of articular impaction and
comminution.
Type C fractures are complete metaphyseal
fractures with articular involvement; these are
subdivided into groups C1, C2, and C3, based
on the extent of metaphyseal and articular
comminution
10. Rüedi and Allgöwer
CLASSIFICATION
.Type I fractures are nondisplaced cleavage
fractures that involve the joint surface
Type II fractures have cleavage-type fracture
lines with displacement of the articular surface,
but minimal comminution;
Type III fractures are associated with
metaphyseal and articular comminution.
16. MANAGEMENT
In undisplaced n debilitated pts with good skin
condition,non operative treatment
long leg cast for 6 weeks
Then brace and rom exercises
Disadvantages:
Loss of reduction
Inability to reduce intraarticular fractures
Inabilty to monitor soft tissue status
17. In case of bad skin condition-
While waiting…
Limb Elevation
Foot pumps
Manage blisters
Debride, Silvadene
Optimize condition
Nutrition
smoking cessation
18. TREATMENT OPTIONS
Nondisplaced fractures- A1, B1, and C1:
1. Cast immobilization
2. Calcaneal traction- Later cast immobilization
3. Ligamentotaxis with ex-fix
4. Limited fixation with 3.5-mm or 4-mm screws
5. percutaneous or limited open reduction
All displaced fractures:
Staged surgery -More recently, staged
protocols have been advocated
19. Staged surgery
First stage:
External fixator spanning the ankle joint.
With or without plating fibula
Second stage
Soft tissue swelling had subsided
ORIF, reconstruction of the articular
surface
Limited incision
20. EX-FIX MODALITIES
1. traditional half-pin fixators spanning the ankle
2. articulated half-pin fixators that allow ankle
motion
3. half-pin fixators that do not span the ankle
4. hybrid fixators that combine tensioned wires with
half-pins in the tibial diaphysis and do not span the
ankle joint.
26. Orif and plate fixation to achieve precisely
reduced articular surface
To min. complications
Use of precountoured low profile implants and mini fragment
screws are used
Antermedial incision over tibia avoided
Use of indirect techniques to minimize soft yissue stipping.
Use of percutaneous /MIPPO for plate fixation
