Pilon fracture

Pilon fracture
File:File:Pilon fracture xray.jpg
Synonyms	Plafond fracture
Pronounce
Field
Symptoms
Complications
Onset
Duration
Types
Causes
Risks
Diagnosis
Differential diagnosis
Prevention
Treatment
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Frequency
Deaths

A pilon fracture, is a fracture of the distal part of the tibia, involving its articular surface at the ankle joint. Pilon fractures are caused by 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 fixate and are historically associated with high rates of complications and poor outcome.<ref name=Mandi-2012>Mandi, DM,

 Pilon fractures, 
 Clinics in Podiatric Medicine and Surgery, 
 
 Vol. 29(Issue: 2),
 pp. 243–278, viii,
 DOI: 10.1016/j.cpm.2012.01.001,
 PMID: 22424487,</ref><ref name=Liporace-2012>, 
 Decisions and staging leading to definitive open management of pilon fractures: where have we come from and where are we now?, 
 J Orthop Trauma, 
 
 Vol. 26(Issue: 8),
 pp. 488–98,
 DOI: 10.1097/BOT.0b013e31822fbdbe,
 PMID: 22357091,</ref><ref name=Crist-2011>Crist, BD, 
 Pilon Fractures: Advances in Surgical Management, 
 The Journal of the American Academy of Orthopaedic Surgeons, 
 
 Vol. 19(Issue: 10),
 pp. 612–22,
 DOI: 10.5435/00124635-201110000-00005,
 PMID: 21980026,</ref><ref name=rayan2018/>

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 />

Classification

Pilon fractures are categorized by two main X-ray schemes, Ruedi-Allgower classification system.<ref name=rayan2018>,

 Open reduction internal fixation versus external fixation with limited internal fixation for displaced comminuted closed pilon fractures: A randomised prospective study., 
 Journal of Orthopaedics, Trauma and Rehabilitation., 
 
 Vol. 24,
 pp. 84–89,
 DOI: 10.1016/j.jotr.2017.08.001,</ref> and Müller AO Classification of fractures.<ref name="pmid26407690">, 
 Management of high-energy tibial pilon fractures, 
 Strategies Trauma Limb Reconstr, 
 
 Vol. 10(Issue: 3),
 pp. 137–47,
 DOI: 10.1007/s11751-015-0231-5,
 PMID: 26407690,
 PMC: 4666229,</ref>

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, involvement of soft tissue, and the fracture pattern. Treatment strategies and fixation methods used include internal and 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>,

 Tibial pilon fractures: which method of treatment?, 
 Injury, 
 
 Vol. 41(Issue: 11),
 pp. 1183–90,
 DOI: 10.1016/j.injury.2010.08.041,
 PMID: 20870227,</ref> Appropriate wound management is important to reduce the high rate of infectious complications and secondary wound healing problems associated with open pilon fractures.<ref name=Tarkin-2008>Tarkin, IS, 
 An Update on the Management of High-energy Pilon Fractures, 
 Injury, 
 
 Vol. 39(Issue: 2),
 pp. 142–54,
 DOI: 10.1016/j.injury.2007.07.024,
 PMID: 18054017,</ref>  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 />

See also

• Ankle fracture