Pilon fracture: Difference between revisions

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==Background==
==Background==
*High energy axial loading injury that drives tibial plafond (French for ceiling) into talar dome
*Fracture of the distal end of the tibia aka tibial plafond (French for ceiling) after the talar dome is driven into it
**Motor vehicle accidents, falls from height
**Typically due to high energy axial loading injuries (motor vehicle accident, fall from height)
**"Pilon" is another word for pestle, a tool used to grind substance in a mortar
*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


==Clinical Features==
==Clinical Features==
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==Evaluation==
==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
*Assess distal pulse, motor, and sensation
*Inspect skin for signs of open fracture
*Inspect skin for signs of open fracture
[[File:Pilon fracture.jpg|thumb|Pilon Fracture]]
*Suspect other fracture as well, given mechanism:
*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


===Imaging===
==Management==
*Plain radiographs
{{General Fracture Management}}
**AP, Lateral, and Mortise views of ankle
*CT often necessary to reveal amount of articular surface displacement/develop treatment plan


==Management==
===Specific Management===
*[[Long leg posterior splint]]
*[[Long leg posterior splint]]
*Consult ortho for surgery
*Consult ortho for surgery


==Disposition==
==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==

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

Evaluation

Pilon fracture
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,
  • Monitor for compartment syndrome

Management

General Fracture Management

Specific Management

Disposition

  • If stabilized without evidence of significant articular displacement, can be managed as outpatient after consultation with Ortho

Admit for

See Also

References