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Pilon Fracture: Causes, Symptoms, Diagnosis, and Treatment

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Pilon fracture is a rare form of fracture of the base of the tibia proximal to the ankle. Explore the article below to know more.

Medically reviewed by

Dr. Anuj Gupta

Published At June 7, 2023
Reviewed AtJune 15, 2023

Introduction:

The lower leg comprises two long bones, namely the tibia and fibula. These are separate bones that connect the ankle and the knee. The tibia is known as the shinbone, as it is the largest of the two bones. The base of the tibia is associated with the ankle joint, whereas the upper portion is associated with the knee joint. The function of the tibia is weight-bearing, and the fibula, in conjugation with the tibia, provides support and stability for the ankle bone.

What Is a Pilon Fracture?

Pilon fracture is a rare fracture that primarily involves the distal region of the tibia, wherein the articular or basal surface at the ankle joint is affected. Pilon fractures are absolutely a rare form of fracture occurring in the ankle aspect, of about one to ten percent of the total fractures of the tibia or lower leg. Nevertheless, middle-aged males with 25 to 50 years are more susceptible to pilon fractures with vehicle accident events. In cases of females, older adults with osteoporosis can encounter pilon or other ankle fractures with even a minimal fall.

What Are the Types of Pilon Fractures?

Generally, fractures can be classified into several types based on the nature of the break. So, the following general classification is applicable to any bone.

  • Compound Fracture: Compound or open fracture results when the fracture is open and pierces the broken fragments through the skin. About twenty percent of the pilon fractures are compound ones.

  • Closed Fracture: It is known as a fracture that does not break or open the surrounding skin structure.

  • Complete Fracture: The bone breaks into two segments, a complete fracture.

  • Displaced Fracture: The fractured segment is displaced where it does not abide by the normal alignment.

  • Comminuted Fracture: It is characterized by a breakage into multiple segments or fragments.

  • Spiral Fracture: The condition of fracture spiraling across the bone is called a spiral fracture.

  • Impacted Fracture: It results when the bone fragments get driven into each other by means of force.

In addition, several classification systems determine and describe the fracture. The classification can be based on the break pattern, involvement of the number of bones, and other determinants. One of those includes Ruedi- Allgower classification system for pilon fractures:

  • Type I: It is an articular fracture, where the bone is fractured in or around the joint. The fracture shows no or minimal degrees of displacement, yet the broken segments are still in alignment.

  • Type II: In this type of fracture, the base of the tibia is displaced with no alignment. Nevertheless, comminution is minimal or absent, whereas comminution is known for the fracture of bone into multiple segments.

  • Type III: This type of fracture is the combination of comminuted and impacted fractures. So, the Type III fracture results in the breakage of the bone into more than two segments, and those broken ends get driven by each other. Type III fractures are seen in about twenty-five to seventy-one of the pilon fracture cases.

What Are the Signs and Symptoms of Pilon Fracture?

The symptoms of pilon fractures are more of the ankle fractures concerning the ankle and specifically the tibia bone. The most common clinical signs of pilon fractures include the following:

  • Intense degrees of pain in the lower extremities and ankle.

  • Difficulty loading weight on the affected or fractured leg.

  • Bruising or blisters around the ankle region.

  • Swelling of the ankle.

  • Twisted or deformed ankle.

What Causes Pilon Fractures?

Pilon fractures generally result when the talus bone undergoes fracture and gets driven into the lower leg bones, such as the fibula and tibia, with the breaking force at the ankle joint. There is no solitary cause for the pilon fracture. In contrast, several instances can induce pilon fractures which include the following.

  • High-Impact Events: High-impact events are the major and significant causes of pilon fractures. The events include vehicle accidents, skiing assaults, and falls.

  • Diseases: The diseases or conditions causing bones to weaken can cause pilon type of fractures, but this form is rare compared to those high-impact events. So, osteoporosis, a bone-weakening condition, is attributable to the cause of pilot fractures even with a minimal fall.

How Is Pilon Fracture Diagnosed?

Medical healthcare professionals are primarily involved in symptom evaluation, physical examination, and medical history assessment for the evaluation of the pain and fracture of the ankle. Then, a range of X-ray imaging techniques is prescribed, which help in diagnosis and treatment processes. X-rays at distinct views help assess the type and severity of pilon fractures. Computed tomography (CT) scan presents the detailed features of the fracture and thus aids in the surgery preliminaries.

What Are the Treatment Options for Pilon Fracture?

The intervention for pilon fracture involves medical and surgical treatments. Non-surgical options are recommended for fractures with no displacement and proper alignment. The surgery is highly prescribed for complex fractures.

Non-Surgical Treatments

  • Rest: The doctors advise to take rest with keeping the affected leg in elevation. So, one must not load the weight and stress on the fractured leg.

  • Medications: Pain relievers are prescribed. In addition, doctors might prescribe anticoagulants for the prevention of blood clots in the veins.

  • Walking Aids: The doctors would advise using walking aids during the period of healing and recovery.

  • Physical Therapy: Physical therapist will prescribe a range of stretches and strengthening exercises as a means to restore stability and strength.

  • Casting: For the stabilization of the fractured segment and promotion of healing, the doctors recommend the use of a boot, cast, or splint.

Surgery

  • Open Reduction: The open reduction is done in conjugation with internal fixation. During this procedure, the broken bone fragments are repositioned with the actual alignment, and then the positioned fragments are clenched together in the position using metal plates and screws. These are attached to the outer aspect of the bone. This surgical intervention is indicated only when the supporting structures and skin of the fractured bone are healthy.

  • External Fixation: Surgical removal of the excess tissue is primarily effective, and secondary approaches are towards the configuration of the fragments. During this surgical intervention, an incision is made in the skin, and metal pins are introduced through the bones. The pins poke out of the skin and then are connected to the bars outside the bone. Here, the external fixator is a frame that helps bear the bone in a secure and actual position. The doctors might recommend other surgery following this procedure.

Conclusion:

Pilon fractures are a rare form of fracture occurring in the ankle aspect; it is associated with intense pain, swelling, and difficulty in weight bearing. Interventions of any fracture are to address the pattern of the break and depth of the bone involvement. Then the underlying and primary cause of the fracture is assessed, whether it can be an injury, accident, or direct blow. Relief can be effectively achieved to a greater extent by optimizing the use of medications, physical therapies, or surgical interventions that doctors suggest.

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Dr. Anuj Gupta
Dr. Anuj Gupta

Spine Surgery

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