A pilon fracture is a type of fracture involving the distal tibia. These are considered to represent 1-10% of all lower limb fractures. 6
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Typically occurs as a result of an axial loading injury which drives the talus into the tibial plafond.
Several classification systems exist. Frequently adopted is the one proposed by Ruedi and Algower 5 :
- type I: articular fracture with minimal or no displacement
- type II: displacement of the articular surface but with minimal or no comminution.
- type III: marked comminution as well as articular impaction
Plain film / CT
Exact features vary with type, but commonly:
- fractures lines are seen extending into the tibiotalar articular surface.
- oblique fracture components may extend proximally into the tibial shaft.
- depending in the severity, fractures may also involve the fibula.
History and etymology
Derived from the French word pilon (pestle), an instrument used for crushing and pounding and usually used with a mortar.
- 1. Cheung Y, Perrich KD, Gui J et-al. MRI of isolated distal fibular fractures with widened medial clear space on stressed radiographs: which ligaments are interrupted? AJR Am J Roentgenol. 2009;192 (1): W7-12. doi:10.2214/AJR.08.1092 - Pubmed citation
- 2. Topliss CJ, Jackson M, Atkins RM. Anatomy of pilon fractures of the distal tibia. J Bone Joint Surg Br. 2005;87 (5): 692-7. doi:10.1302/0301-620X.87B5.15982 - Pubmed citation
- 3. Haapamaki VV, Kiuru MJ, Koskinen SK. Ankle and foot injuries: analysis of MDCT findings. AJR Am J Roentgenol. 2004;183 (3): 615-22. AJR Am J Roentgenol (full text) - Pubmed citation
- 4. Tscherne H, Schatzker J. Major fractures of the pilon, the talus, and the calcaneus, current concepts of treatment. Springer Verlag. (1993) ISBN:0387558373. Read it at Google Books - Find it at Amazon
- 5. Chen SH, Wu PH, Lee YS. Long-term results of pilon fractures. Arch Orthop Trauma Surg. 2007;127 (1): 55-60. doi:10.1007/s00402-006-0225-3 - Pubmed citation
- 6. Sirkin M, Sanders R. The treatment of pilon fractures. Orthop. Clin. North Am. 2001;32 (1): 91-102. - Pubmed citation