Pilon Fracture

Result of high energy trauma resulting with a heavy axial force of talus which bursts tibial plafond over  talus 

AP radiograph of Ankle shows a multifragmentary Pilon fracture.


                                        https://ota.org/for-patients/find-info-body-part/4687

How do you approach ?

    ATLS review

    R/o concomitant injuries

    R/o compartment syndrome

    NV status , observe signs of open injury or degloving injury

    temporary splinting, analgesia, obtain AP/Lateral views and  CT -study

     plan and do  definitive management 


Classification of Pilon Fractures 

        Type 1 - essentially non-displaced

                 2 - displaced with communition

                3  - metaphyseal or articular communition

What is the primary treatment for this fracture ?

        monitor signs of compartment syndrome

        transfer to theatre

        place an ex-fixator - damage control surgery

                    keep limb out to length

                    maintain alignment to avoid further insult to soft tissues

         +/- fix fibula at the same setting to restore length

What is the definitive treatment ?

        CT-scan -preoperative planning

         Wait 7-10 days for soft tissues to be in appropriate condition for surgery

        Openly reduce and fix along AO (Arbeitsgemeinschaft fur Osteosynthesefragen ) principles

          Non-surgical treatment - an option but gives a poor result

          Surgical Treatment - Ex fixator such as fine wire Ilizarov frame.

                                            ORIF with Plating

                                            Goals - 

                                                    anatomical reconstruction of articular surfaces 

                                                     restoration of correct rotational alignment

                                                    


                            https://journals.sagepub.com/doi/10.1177/0036933015569159

Complications to warn the patients 

    Short term 

                Wound break down

                Infection

                Compartment syndrome    

                Complex Regional Pain Syndrome(CRPS)

    Mid  Term

                Non-union

                Mal-union

      Long term

                Limitations of ankle movement

                Post-traumatic OA - 80 %

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