Presentation
Presenting with a deformed, bruised, swollen right ankle with severe pain, and unable to bear weight, besides a gross right elbow displacement after falling from a 5 meter scaffold as a result of workplace injury.
Patient Data
Comminuted fracture of the distal metaepiphysis of the right tibia extending to its distal diaphysis, highly suggestive of pilon fracture, and comminuted fracture of the distal diaphyseal region of the fibula. There is a considerable displacement and angular deformity.
The patient also presents a posterior dislocation of the elbow, but there are no signs of associated fracture.
Comminuted tibial platform fracture that extend into the metadiaphyseal region associated with a comminuted distal diaphyseal fracture of the fibula. There is a little articular offset, and several small sub-millimeter intra-articular fragments. All these features are highly compatible to the type III of Ruedi and Allgower classification for pilon fractures.
After closed reduction of the elbow dislocation.
38 days after surgery.
Case Discussion
Pilon fracture comprises a wide range of trauma mechanisms and usually presents a considerable comminuted pattern. Even when surgical intervention is performed in proper timing, with expert surgical techniques and host factors are favorable, restoration of function and avoidance of complications are not always achievable.
Contributed by Dr. Guilherme Pioli Resende M.D. and Dr. Marcello Antônio de Rezende Basilio M.D.
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