Pilon fracture: Difference between revisions

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{{Infobox medical condition (new)
 
| name           = Pilon fracture
{{Infobox medical condition
| image           = File:Pilon fracture xray.jpg
| name = Pilon Fracture
| caption         = [[X-ray]] of a fracture involving the articular surface of the Tibia
| image = <!-- Image of Pilon Fracture -->
|
| caption = X-ray of a Pilon Fracture
| pronounce      = 
| field = [[Orthopedics]]
| field           =
| symptoms = Severe pain, swelling, inability to bear weight
| synonyms        = '''Plafond fracture'''
| complications = [[Arthritis]], [[Infection]], [[Nonunion]]
| symptoms       =  
| onset = Sudden, due to trauma
| complications   =  
| duration = Varies, often weeks to months
| onset           =  
| causes = High-energy impact, such as car accidents or falls
| duration       =
| risks = [[Osteoporosis]], high-impact sports
| types          =  
| diagnosis = [[X-ray]], [[CT scan]]
| causes         =  
| treatment = [[Surgery]], [[Physical therapy]]
| risks           =  
| prognosis = Depends on severity and treatment
| diagnosis       =
| frequency = Rare
| differential    =
| prevention      =  
| treatment       =
| medication      =  
| prognosis       =  
| frequency       =
| deaths          =  
}}
}}


A '''pilon fracture''',  is a [[Fracture (bone)|fracture]] of the [[distal]] part of the [[tibia]], involving its [[articular surface]] at the [[ankle joint]]. Pilon fractures are caused by [[Rotational force|rotational]] or axial forces, mostly as a result of falls from a height or motor vehicle accidents. Pilon fractures are rare, comprising 3 to 10 percent of all fractures of the tibia and 1 percent of all lower extremity fractures, but they involve a large part of the weight-bearing surface of the tibia in the ankle joint. Because of this, they may be difficult to [[Internal fixation|fixate]] and are historically associated with high rates of complications and poor outcome.<ref name=Mandi-2012>{{cite journal|last=Mandi|first=DM|author2=Belin, RP |author3=Banks, J |author4= Barrett, B |title=Pilon fractures |journal=Clinics in Podiatric Medicine and Surgery|date=Apr 2012|volume=29|issue=2|pages=243–278, viii|pmid=22424487 |doi=10.1016/j.cpm.2012.01.001}}</ref><ref name=Liporace-2012>{{cite journal | vauthors = Liporace FA, Yoon RS | title = Decisions and staging leading to definitive open management of pilon fractures: where have we come from and where are we now? | journal = J Orthop Trauma | volume = 26 | issue = 8 | pages = 488–98 | date = August 2012 | pmid = 22357091 | doi = 10.1097/BOT.0b013e31822fbdbe }}</ref><ref name=Crist-2011>{{cite journal|last=Crist|first=BD|author2=Khazzam, M |author3=Murtha, YM |author4= Della Rocca, GJ |title=Pilon Fractures: Advances in Surgical Management |journal=The Journal of the American Academy of Orthopaedic Surgeons|date=Oct 2011|volume=19|issue=10|pages=612–22|pmid=21980026|doi=10.5435/00124635-201110000-00005}}</ref><ref name=rayan2018/>
A '''Pilon fracture''' is a type of [[fracture]] that occurs at the distal end of the [[tibia]], involving the [[ankle joint]]. It is often the result of high-energy trauma, such as a [[motor vehicle accident]] or a fall from a significant height.


''Pilon'' is the French word for "pestle" and was introduced into orthopedic literature in 1911 by pioneer French radiologist [[Étienne Destot]].<ref name=Mandi-2012 />
== Signs and Symptoms ==
Patients with a Pilon fracture typically present with severe [[pain]], [[swelling]], and an inability to bear weight on the affected limb. The [[ankle]] may appear deformed, and there may be visible [[bruising]] or [[lacerations]] if the fracture is open.


== Classification==
== Causes ==
Pilon fractures are categorized by two main X-ray schemes, [[Ruedi-Allgower classification]] system.<ref name=rayan2018>{{cite journal|last1=Rayan|first1=A|last2=Kotb|first2=A|last3= Elmoatasem|first3=EM|last4= Samir|first4=S|last5= EL-Sobky|first5=TA|last6= El-Hawi|first6=E|last7=Mahran|first7=M|title= Open reduction internal fixation versus external fixation with limited internal fixation for displaced comminuted closed pilon fractures: A randomised prospective study.|journal= Journal of Orthopaedics, Trauma and Rehabilitation.|volume=24|pages=84–89|date=17 April 2018|doi= 10.1016/j.jotr.2017.08.001}}</ref> and [[Müller AO Classification of fractures]].<ref name="pmid26407690">{{cite journal | vauthors = Jacob N, Amin A, Giotakis N, Narayan B, Nayagam S, Trompeter AJ | title = Management of high-energy tibial pilon fractures | journal = Strategies Trauma Limb Reconstr | volume = 10 | issue = 3 | pages = 137–47 | date = November 2015 | pmid = 26407690 | pmc = 4666229 | doi = 10.1007/s11751-015-0231-5 }}</ref>
Pilon fractures are usually caused by high-energy impacts. Common scenarios include [[car accidents]], falls from heights, or sports injuries. The force of the impact drives the [[talus]] bone into the [[tibia]], causing the fracture.
 
== Diagnosis ==
Diagnosis of a Pilon fracture is typically made using [[imaging studies]]. An [[X-ray]] is the first step, which can reveal the extent of the fracture. A [[CT scan]] may be used to provide more detailed images of the fracture pattern and to assist in surgical planning.


== Treatment ==
== Treatment ==
The treatment of pilon fractures depends on the extent of the injury. This includes the involvement of other bones such as the [[fibula]] and the [[Talus bone|talus]], involvement of [[soft tissue]], and the fracture pattern. Treatment strategies and fixation methods used include [[Internal fixation|internal]] and [[External fixation|external]] fixation, as well as staged approaches, with the aim of reducing the fracture, reconstructing the involved bones and restoration of articular surface congruence, with minimal insult to soft tissues.<ref name=rayan2018/><ref name=Calori-2010>{{cite journal|vauthors=Calori GM, Tagliabue L, Mazza E, de Bellis U, Pierannunzii L, Marelli BM, Colombo M, Albisetti W |title=Tibial pilon fractures: which method of treatment?|journal=Injury|date=Nov 2010|volume=41|issue=11|pages=1183–90|pmid=20870227|doi=10.1016/j.injury.2010.08.041}}</ref> Appropriate wound management is important to reduce the high rate of infectious complications and secondary wound healing problems associated with [[Open fracture|open]] pilon fractures.<ref name=Tarkin-2008>{{cite journal|last=Tarkin|first=IS|author2=Clare, MP |author3=Marcantonio, A |author4= Pape, HC |title=An Update on the Management of High-energy Pilon Fractures |journal=Injury|date=Feb 2008|volume=39|issue=2|pages=142–54|pmid=18054017 |doi=10.1016/j.injury.2007.07.024}}</ref>  [[Vacuum assisted closure wound therapy|Vacuum-assisted wound closure therapy]] and using a ''staged protocol'' (awaiting soft-tissue recovery before extensive reconstructive efforts) may play a positive role.<ref name=Tarkin-2008 />
Treatment of Pilon fractures often requires [[surgical intervention]]. The goals of surgery are to realign the bone fragments, restore the normal anatomy of the ankle joint, and stabilize the fracture with [[plates]] and [[screws]].


== See also ==
Post-surgery, patients may need [[physical therapy]] to regain strength and mobility in the ankle. The recovery process can be lengthy, and full recovery may take several months.
*[[Ankle fracture]]


==References==
== Complications ==
Complications of Pilon fractures can include [[arthritis]] due to joint surface damage, [[infection]] if the fracture is open, and [[nonunion]] or [[malunion]] of the fracture. Long-term outcomes depend on the severity of the fracture and the success of the treatment.


== See Also ==
* [[Fracture]]
* [[Orthopedic surgery]]
* [[Ankle injuries]]
== References ==
{{Reflist}}
{{Reflist}}
== External links ==
{{Medical resources
|  DiseasesDB    =
|  ICD10          = {{ICD10|S|82|3}}
|  ICD9          = {{ICD9|}}
|  ICDO          =
|  OMIM          =
|  MedlinePlus    =
|  eMedicineSubj  = 
|  eMedicineTopic =
|  eMedicine_mult =
|  MeshID        =
}}
{{Fractures |state=autocollapse}}


[[Category:Bone fractures]]
== External Links ==
[[Category:Medical terminology]]
* [Orthopedic Trauma Association](https://ota.org)
* [American Academy of Orthopaedic Surgeons](https://www.aaos.org)
 
[[Category:Orthopedic injuries]]
[[Category:Fractures]]
[[Category:Ankle]]

Revision as of 16:52, 29 December 2024


Pilon Fracture
Synonyms N/A
Pronounce N/A
Specialty N/A
Symptoms Severe pain, swelling, inability to bear weight
Complications Arthritis, Infection, Nonunion
Onset Sudden, due to trauma
Duration Varies, often weeks to months
Types N/A
Causes High-energy impact, such as car accidents or falls
Risks Osteoporosis, high-impact sports
Diagnosis X-ray, CT scan
Differential diagnosis N/A
Prevention N/A
Treatment Surgery, Physical therapy
Medication N/A
Prognosis Depends on severity and treatment
Frequency Rare
Deaths N/A


A Pilon fracture is a type of fracture that occurs at the distal end of the tibia, involving the ankle joint. It is often the result of high-energy trauma, such as a motor vehicle accident or a fall from a significant height.

Signs and Symptoms

Patients with a Pilon fracture typically present with severe pain, swelling, and an inability to bear weight on the affected limb. The ankle may appear deformed, and there may be visible bruising or lacerations if the fracture is open.

Causes

Pilon fractures are usually caused by high-energy impacts. Common scenarios include car accidents, falls from heights, or sports injuries. The force of the impact drives the talus bone into the tibia, causing the fracture.

Diagnosis

Diagnosis of a Pilon fracture is typically made using imaging studies. An X-ray is the first step, which can reveal the extent of the fracture. A CT scan may be used to provide more detailed images of the fracture pattern and to assist in surgical planning.

Treatment

Treatment of Pilon fractures often requires surgical intervention. The goals of surgery are to realign the bone fragments, restore the normal anatomy of the ankle joint, and stabilize the fracture with plates and screws.

Post-surgery, patients may need physical therapy to regain strength and mobility in the ankle. The recovery process can be lengthy, and full recovery may take several months.

Complications

Complications of Pilon fractures can include arthritis due to joint surface damage, infection if the fracture is open, and nonunion or malunion of the fracture. Long-term outcomes depend on the severity of the fracture and the success of the treatment.

See Also

References

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External Links

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