Pilon fracture

Background

• High energy axial loading injury that drives tibial plafond (French for ceiling) into talar dome
  • Motor vehicle accidents, falls from height
  • "Pilon" is another word for pestle, a tool used to grind substance in a mortar
• Also known as a tibial plafond fracture

Clinical Features

• Ankle pain/deformity
• Inability to bear weight
• Local tenderness to palpation

Differential Diagnosis

Distal Leg Fracture Types

• Tibial plateau fracture
• Tibial shaft fracture
• Pilon fracture
• Maisonneuve fracture
• Tibia fracture (peds)
• Ankle fracture
  • Ankle fracture (peds)
    • Tillaux fracture
• Foot and toe fractures

Evaluation

• Assess distal pulse, motor, and sensation
• Inspect skin for signs of open fracture

Pilon Fracture

• Suspect other fracture as well, given mechanism:
  • Lumbar spine (esp L1), calcaneus, talar dome, tibial plateau, femoral neck, acetabulum,
• Monitor for compartment syndrome

Imaging

• Plain radiographs
  • AP, Lateral, and Mortise views of ankle
• CT often necessary to reveal amount of articular surface displacement/develop treatment plan

Management

• Long leg posterior splint
• Consult ortho for surgery

Disposition

• If stabilized without evidence of significant articular displacement, can be managed as outpatient after consultation with Ortho
• Admit for:
  • Open fracture
  • Signs of neurovascular compromise
  • Concern for compartment syndrome

See Also

• Fractures (Main)
• Ankle (Main)