Pilon fracture of the hand

Last revised by Andrew Murphy on 16 Aug 2021

The pilon fracture of the hand is a comminuted, intraarticular fracture involving a proximal interphalangeal joint of the hand. The fracture is generally reported to involve the more ulnar digits and the pattern is considered unstable with case reports documenting poor outcomes. 


The injury occurs as a result of compressive axial loading of a digit. 

Radiographic features

Plain radiograph / CT

Two main geometries of comminution are reported. In the first type there is central impaction within the basal articular surface of the middle phalanx with lateral fragments being splayed in both coronal and sagittal planes. In the second subtype the fracture geometry demonstrates a T or Y type pattern at the base of the middle phalanx. 

History and etymology

The term is derived from the Latin word pilum (a "pounder"). 

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