Pilon Fracture of the Ankle

What is a pilon fracture of the ankle?

A pilon fracture is a type of break of the shinbone (tibia) that happens near the ankle. Most of the time, it involves breaks in both the tibia and fibula of the lower leg. The lower ends of these bones make up part of the ankle.

The term “pilon” comes from the French word for pestle. This is an instrument used for crushing. In many pilon fractures, a high-energy impact causes the injury. Because of the high energy involved in this fracture, many people with pilon fractures have additional injuries.

Healthcare professionals classify pilon fractures according to their severity.

Pilon fractures are relatively rare, especially in children and elderly people. Pilon fractures have become more common in recent years because air bags have increased the number of people that survive high-speed car crashes.

What causes a pilon fracture of the ankle?

High-energy impacts most commonly cause pilon fractures. Falls from heights, motor vehicle accidents, and skiing accidents are common causes. Usually, the force from the impact drives a bone from the foot (the talus) into the tibia. The energy from the impact fractures the tibia and usually the fibula. It often causing other injuries as well.

What are the symptoms of a pilon fracture of the ankle?

Pilon fractures cause a number of symptoms, like:

  • Swelling of the leg and ankle
  • Bruising of the leg and ankle
  • Severe pain and tenderness to touch
  • Inability to put weight on your foot
  • Having an ankle that looks crooked

Your symptoms may vary according to the severity of your injury. You might also have symptoms from additional injuries.

How is a pilon fracture of the ankle diagnosed?

Your healthcare provider will talk to you about your symptoms and about your medical history. Your healthcare provider will do a full physical exam to check you for other injuries. Your healthcare provider will also carefully examine your lower leg and ankle. Your healthcare provider may push on different areas to see whether they are painful to the touch, inspecting the area for swelling. Your healthcare provider will also make sure the blood supply to your foot and ankle is still intact.

Your healthcare provider will probably also order X-rays of your leg, ankle, and foot to see whether you have any broken bones. You might also need a computed tomography (CT) scan to evaluate your injury in more detail. An emergency room healthcare provider often makes your diagnosis.

How is a pilon fracture of the ankle treated?

Some people with pilon fractures will not need surgery. If the bones of your tibia still line up correctly, you might not need surgery. Nonsurgical treatments include:

  • Splints, to initially hold your ankle in place
  • Casts or boots, once your swelling goes down
  • Pain medicines

Your healthcare provider might also recommend nonsurgical treatment for your pilon fracture if you have other medical conditions that might make surgery more of a risk.

If the bones of your pilon fracture are out of place, you will probably need surgery. Your healthcare provider might temporarily delay your surgery until your swelling has gone down. While you wait, you might need to have a splint or other type of immobilization.

During surgery, your surgeon can perform internal fixation. The purpose of internal fixation is to permanently put your bones in the correct position to help them heal. Your healthcare provider will use special plates and screws through the bone to keep the bones in the correct configuration. Depending on the extent of your injuries, your healthcare provider might do this in 2 separate surgeries.

After your leg has healed a little, your healthcare provider may prescribe a removable brace or splint, so that you can do physical therapy when you remove it. These exercises will help restore and maintain your range of motion and strength. You’ll need to use crutches or a cane for several months after your injury.

Your healthcare provider also might prescribe a medicine to prevent blood clots in your leg while you recover (a “blood thinner”).

Your healthcare provider might also give you specific recommendations about your diet, like making sure you get a diet rich in calcium, vitamin D, and protein. Your healthcare provider may ask you to avoid certain over-the-counter medicines for pain, because these may interfere with bone healing. If you smoke, your healthcare provider may encourage you to stop smoking because this can interfere with bone healing as well.

What are the complications of a pilon fracture of the ankle?

You might have complications from your pilon fracture, such as:

  • Stiffness in your joint (which physical therapy may help)
  • Ankle arthritis, causing chronic ankle pain
  • Infection, which may need treatment with antibiotics or follow-up surgery
  • A bone that fails to heal properly, which might need follow-up surgery
  • Pain from the plates and screws used in your surgery (you may have these removed at a later date)
  • Problems with wound healing
  • Blood vessel or nerve damage from your pilon fracture
  • Blood clot

Your risk of complications may vary according to your other medical conditions and the severity of your injury. For example, you are more likely to develop arthritis in your ankle joint if you had a severe pilon fracture. Following all of your healthcare provider’s instructions carefully may help reduce your risk of complications.

When should I call my healthcare provider?

Call your healthcare provider if any of the following happens:

  • Your wound is red or oozing
  • You have a high fever or chills
  • You have numbness in your leg
  • Your pain is worsening instead of improving
  • You have any sudden, severe symptoms, like sudden shortness of breath (tell your healthcare provider right away)

Key points about a pilon fracture of the ankle

A pilon fracture is a type of break of the shinbone that happens near the ankle. Most of the time, high-impact injury breaks both bones of the lower leg.

  • If you have a pilon fracture, you might have bruising, deformity, swelling, or pain. You will not be able to put weight on your foot.
  • Your healthcare provider can diagnose your pilon fracture with the help of a medical history, physical exam, and X-ray imaging.
  • If your pilon fracture is mild, you might receive treatment with splints, casts, and pain medicines.
  • Many people with pilon fractures will need surgery. Your healthcare provider might wait until your swelling goes down to perform the surgery.
  • Some people with pilon fractures experience complications, like arthritis in the ankle or an infection. Following your healthcare provider’s instructions may help you reduce your chances of these complications.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.
Online Medical Reviewer: Joseph, Thomas N., MD
Online Medical Reviewer: Moloney, Amanda Jane (Johns), PA-C, MPAS, BBA
Last Review Date: 10/1/2016
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