Pilon fracture: Difference between revisions
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==Background== | ==Background== | ||
* | *Fracture of the distal end of the tibia aka tibial plafond (French for ceiling) after the talar dome is driven into it | ||
** | **Typically due to high energy axial loading injuries (motor vehicle accident, fall from height) | ||
*Also known as a tibial plafond fracture | *Also known as a tibial plafond fracture | ||
*Fairly common; account for 5-10% of all tibial fractures | |||
*Average age of occurrence is 35-45 years old; males > females | |||
==Diagnosis== | ==Clinical Features== | ||
*Suspect other | *Ankle pain/deformity | ||
*Inability to bear weight | |||
*Local tenderness to palpation | |||
==Differential Diagnosis== | |||
{{Distal leg fractures DDX}} | |||
==Evaluation== | |||
[[File:Pilon fracture xray.jpg|thumb|Pilon fracture]] | |||
[[File:Pilon fracture.jpg|thumb|Pilon Fracture]] | |||
===Work-Up=== | |||
*Plain radiographs | |||
**AP, Lateral, and Mortise views of ankle | |||
*CT often necessary to reveal amount of articular surface displacement/develop treatment plan | |||
===Diagnosis=== | |||
*Assess distal pulse, motor, and sensation | |||
*Inspect skin for signs of open fracture | |||
*Suspect other fracture as well, given mechanism: | |||
**Lumbar spine (esp L1), calcaneus, talar dome, tibial plateau, femoral neck, acetabulum, | **Lumbar spine (esp L1), calcaneus, talar dome, tibial plateau, femoral neck, acetabulum, | ||
*Monitor for compartment syndrome | *Monitor for compartment syndrome | ||
== | ==Management== | ||
* | {{General Fracture Management}} | ||
===Specific 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== | ==See Also== | ||
*[[Fractures (Main)]] | *[[Fractures (Main)]] | ||
*[[Ankle (Main)]] | *[[Ankle (Main)]] | ||
== | ==References== | ||
<references/> | |||
[[Category: | [[Category:Orthopedics]] | ||
Latest revision as of 15:14, 30 April 2022
Background
- Fracture of the distal end of the tibia aka tibial plafond (French for ceiling) after the talar dome is driven into it
- Typically due to high energy axial loading injuries (motor vehicle accident, fall from height)
- Also known as a tibial plafond fracture
- Fairly common; account for 5-10% of all tibial fractures
- Average age of occurrence is 35-45 years old; males > females
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
- Foot and toe fractures
Evaluation
Work-Up
- Plain radiographs
- AP, Lateral, and Mortise views of ankle
- CT often necessary to reveal amount of articular surface displacement/develop treatment plan
Diagnosis
- Assess distal pulse, motor, and sensation
- Inspect skin for signs of open fracture
- Suspect other fracture as well, given mechanism:
- Lumbar spine (esp L1), calcaneus, talar dome, tibial plateau, femoral neck, acetabulum,
- Monitor for compartment syndrome
Management
General Fracture Management
- Acute pain management
- Open fractures require immediate IV antibiotics and urgent surgical washout
- Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
- Consider risk for compartment syndrome
Specific 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