Pilon Fractures

Mohammed Nabil J AlAli

5th Year Medical Student
At King Faisal University
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Objectives
- OVERVIEW

( anatomy, definition, epidemiology and mechanisms )

- EVALUATION
( Clinical, physical and imaging )

- CLASSIFICATIONS
- ASSOCIATED INJURIES
- TREATMENT
- COMPLICATIONS
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A
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Talus

M
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 What is Pilon Fracture?
Pilon is a French word for pestle ( also known as
Plafond Fracture ) .

It is intraarticular
fracture of the distal
end of the tibia ,
involving the disruption
of the distal tibial
weight-bearing
articular surface .
It is different from ankle fractures .
In most cases, both bones are broken .

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 EPIDEMIOLOGY
Account for approximately 5-7% of all tibia fractures.
But less than 1% of all lower-extremity fractures .
More commonly at average age of 35 to 40 years old.
rare in children and elderly.
Commonly in men than women (3:1)
Because of the energy required to cause this type of
fracture, 25% to 50% of patients have additional
injuries that require treatment.

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 Mechanism
Pilon fractures are most often caused by axial loading (high-
energy impacts or combination),
such as : Fall from height , Motor-vehicle accident .
- Leads to ( high degree of disruption of articular surface and soft tissue affection )

It may be caused by shear loading (rotational or lower-energy

impacts ) such as : Ski accident .
- Leads to ( less degree of disruption of articular surface )

Often affects both bones of the lower leg.

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 EVALUATION

Clinical presentation

Physical examination

Imaging

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E
V Clinical presentation

A
L
Signs and symptoms
U include an inability to bear weight , marked pain , marked
swelling , and evidence of soft tissue injury and deformity ( out
A of place ) .

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E
V Physical examination

A Neurovascular examination
include distal pulses , capillary refill , motor and sensory examination .

L Soft tissue
- Closed fractures : classified using the method of Tscherne

U - Opened fractures : classified using the method of Gustilo .

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E
V Imaging
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E
V Imaging

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 CLASSIFICATIONS
Association for Osteosynthesis/Orthopedic
trauma association (AO/OTA) Classification

Has good interobserver and intraobserver

agreement at the type level .

Reudi and Allgower Classification

Has good interobserver and intraobserver

agreement at the group level
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C
L Reudi and Allgower Classification
A
S Type I
S Fracture involving
I minimal displacement
F
Type II
I
Significant
C displacement of the
A joint surface
T
Type III
I
Impaction and
O comminution of the
N articular surface
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C
L AO/OTA Classification
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 ASSOCIATED INJURIES

Other skeletal injuries

Soft tissue injuries
- open fractures
- closed fractures
Neurovascular injuries
Other body parts injuries

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T TREATMENT and RATIONAl
R
E Treatment goals
A Treatment options
T Bony considerations
M soft tissue considerations
E Timing of surgery
N
T
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T Treatment goals
R - Anatomical restoration of distal tibial articular surface .
- Early ankle range of motion.
E
A Treatment options
T Non-surgical Surgical
( to manage ( To manage displaced
M non-displaced fractures) fractures )
E Cast and Splints Modern methods :
N (ORIF) and external
fixation with or without
T limited internal fixation
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T Bony considerations
R Tibia Fibula
- Comminution
E - Lower energy : (ORIF) ORIF with plate and
A - High energy + large scrow
number of small
T articulations :

M external fixation with or

without limited internal fixation Remember the most
E - Diaphyseal extention important is restore
Tibia
Typically epi and
N meta of fracture is
T heal more rapid .
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T
R soft tissue considerations

E Low-energy injuries : High-energy injuries :

By ORIF By external fixation with
A or without limited
internal fixation
T
M
E Timing of surgery
Depend on soft tissue affection .
N
T
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T
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T A splint Plates and screws An external fixator

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 ANATOMICAL
CONSEDARATIONS AND
SURGICAL TECHNIQUES
ORIF
External fixation
- Unilateral
- ilizarvo ( consists of fine wire 1.8mm for interfragmentary fixation ) .
- hybird ( ring with wire distally )

Soft tissue
Ligamentotaxis
When traction is applied across the ankle joint , the intraarticular fragments
may be reduced by pull of the capsule and ligamentous structures .

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 COMPLICATIONS
Sever complications following ORIF of tibial fractures
range from 10-55% and some can lead to amputation

Soft tissue slough.

Infections .
Neurovascular injuries.
Bone healing problems
( Mal-alignment, Mal-union and Non-union ) .
Painful plates and screws.
Decreased ankle joint range of motion.
Chronic edema .
Posttraumatic arthritis .
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Any Question ?
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REFERENCES
- Review of Orthopaedic
Trauma by Mark R.Brinker , M.D.
- AAOS (press on the title )

- Medescape (press on the title )

- UpToDate (press on the title )

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Thank you

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