Pilon fracture

Last revised by Travis Fahrenhorst-Jones on 28 Dec 2022

A pilon fracture is a type of distal tibial fracture involving the tibial plafond. These are considered to represent 1-10% of all lower limb fractures 6

Typically high energy injuries and occur as a result of an axial loading which drives the talus into the tibial plafond.

Several classification systems exist. Frequently adopted is the one proposed by Ruedi and Allgower 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
  • by definition, the fracture involves the tibial plafond and the distal tibial articular surface
  • associated fractures of the fibula can be evident, with or without ankle dislocation
  • CT can further define the fracture pattern and assess for tendon subluxation

Derived from the French word pilon (pestle), an instrument used for crushing and pounding and usually used with a mortar.

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Cases and figures

  • Case 1
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  • Case 2: type I
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  • Case 3
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  • Case 4: type III
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  • Case 5
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