Colorado Springs Orthopedic News

Pilon Fracture

Pilon Fracture Of The Ankle

Anyone can get a pilon fracture of the ankle. Pilon fractures can have significant effects on a patient’s life and should therefore be seen as potentially disabling injuries. These injuries were first described more than 100 years ago, and today they are still as challenging to treat. This makes finding the most skilled, experienced surgeons to treat it. Like those at the Colorado Center of Orthopaedic Excellence in Colorado Springs, Colorado. Pilon fractures are often severe and painful injuries that can cause long-term issues, such as arthritis in your ankle joint.

OVERVIEW

Pilon is the French word for “pestle” and was introduced into orthopedic literature in 1911 by pioneer French radiologist Étienne Destot. A pestle is a tool with a rounded end that’s used for crushing and grinding substances. This type of bone break is called a pilon fracture because of the crushing force that often causes them. A pilon fracture of the ankle is relatively rare. Because of the strong impact that causes this fracture, many people with pilon fractures can have additional injuries.

ABOUT THE ANKLE

A pilon fracture is an injury of the ankle joint. The ankle is made up of the bottom end of the tibia bone, the talus bone, and the fibula bone. The talus is the bone just below the tibia, or “shin bone.” The fibula is the smaller bone on the outside of the ankle. These bones are lined with a smooth, low-friction substance called cartilage. This cartilage allows the ankle joint to move smoothly. Ligaments connect bones to bones and hold them together. In the ankle, there are also arteries, veins, and nerves that connect to the muscles and skin of the foot. These run on the inside of the ankle, the outside of the ankle, and in the front of the ankle.

WHAT IS A PILON FRACTURE OF THE ANKLE?

A pilon fracture happens at the bottom of your tibia (the larger of the two bones in your lower leg or your shinbone) near your ankle. In many cases of pilon fractures, the other bone in your lower leg, your fibula, is broken as well. There are several types of pilon fractures depending on the pattern of the break, and there are many classification systems and terms to describe them: 

  • Closed or open (compound) fracture: If the fracture doesn’t break open the surrounding skin, it’s called a closed fracture. If the broken bone pierces through the skin, it’s called an open fracture or a compound fracture. Approximately 20% of pilon fractures are open fractures. Open fractures can lead to infection, which can be dangerous.
  • Complete fracture: A complete fracture happens when the bone breaks into two pieces.
  • Displaced fractures: A displaced fracture means the broken bones do not stay aligned like they normally would.
  • Comminuted fracture: A comminuted fracture means the bone breaks into more than two pieces.
  • Impacted fracture: An impacted fracture happens when the ends of the broken bone are driven into each other.
  • Spiral fracture: Spiral fractures happen when the fracture spirals around the bone.

CAUSES

High-energy impacts most often cause pilon fractures. Falls from heights such as falling off a ladder or roof, skiing accidents, and motor vehicles are common causes. Although pilon fractures caused by low-impact events like a minor fall aren’t that common, people who have osteoporosis are at a higher risk of experiencing a pilon fracture from a low-impact event. People who have a history of falls, especially older people, are more likely to experience a pilon fracture from falling.

SYMPTOMS

  • Swelling of the leg and ankle
  • Bruising of the leg and ankle
  • Severe pain and soreness to the touch
  • Inability to put weight on the foot
  • Hard time standing
  • Decreased mobility
  • Having an ankle that looks crooked or deformed

NON-SURGICAL TREATMENT

If the bones of the tibia still line up correctly, surgery might not be necessary. Non-surgical treatment for pilar fractures of the ankle can include:

  • Rest:  Rest as much as possible with the affected leg elevated so that there isn’t extra pressure on the pilon fracture.
  • Casts, splints, and/or boots: Wear a splint, cast, and/or boot to stabilize your ankle.
  • Walking aids:  Use a walking aid such as crutches to avoid bearing weight on your affected leg. The walking aid might need to be used for up to three months or until the pilon fracture is fully healed.
  • Medications:  Blood thinner medication (anticoagulant) can reduce the risk of having blood clots form in the veins of the legs.
  • Physical therapy: This restores strength in the leg and ankle after the fracture(s) has healed

WHEN IS SURGERY INDICATED?

If a pilon fracture is displaced and the bones aren’t aligned properly, surgery is most likely necessary. Depending on the severity of the fracture and if there are other injuries, the surgeon may delay surgery until the swelling around the ankle has settled, and the patient is healthy enough to undergo surgery to minimize risks such as infection. The goals of pilon fracture surgery are to restore alignment and stability and allow healing of the tibia and fibula at the ankle joint. Once the fractures are healed, the goals are to restore your ankle’s movement and strength.

GETTING THE RIGHT DIAGNOSIS

Pilon fractures require x-rays to be diagnosed so that your surgeon can see the type of pilon fracture you have and how severe it is so they can learn how the fracture needs to be treated. Other images like CT scans might also be used to evaluate your injury in greater detail. Despite advances in imaging technology and surgical approaches, pilon fractures are challenging to treat. This is because pilon fractures often cause damage to the ankle joint itself and the surrounding soft tissues such as muscle and ligaments. It can take individuals a year or more to recover from the injury fully, and long-term ankle arthritis is common following a pilon fracture. Untreated, it may also cause foot deformities that may make it impossible to walk normally. The goal of the orthopedic specialists at Colorado Center of Orthopaedic Excellence in Colorado Springs, Colorado, is to get you back on your feet and back to enjoying your life without pain. Schedule an online appointment today.

Foot & Ankle Specialists

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