Pilon fracture

Case contributed by Dr Camille Janet Dunn

Presentation

Brought in by friend after a fall off ladder, landing on left foot.

Patient Data

Age: 50 years
Gender: Male
X-ray

Before reduction

Spiral fractures of the distal tibial and fibular metadiaphyses.  Comminuted distal fibular fracture. The distal segments demonstrate up to 8 mm lateral displacement and mild lateral angulation.  The distal tibiofibular joint is not widened, and mortise alignment appears normal.

CT

CT post reduction - surgical planning

Comminuted, oblique fracture of distal fibula is mildly displaced.  Comminuted, displaced intra-articular fracture of distal tibia is also noted. Left ankle is immobilized in a plaster back slab.

Conclusion
Comminuted, mildly displaced fractures of distal tibia and fibula.

X-ray

Post ORIF

No hardware complication.  Alignment near anatomical. Ankle mortise appears congruent.

Case Discussion

More specifically this is called a pilon fracture, type C 1,2.  These fractures involve the distal tibia and its articular surface.  Like this patient, pilon fractures usually occur from high-energy trauma leading to axial loading or rotation, therefore, they are often comminuted 2.  Comminuted fracture is where the bone breaks into more than 2 pieces. 

This patient required an ORIF due to instability.  Most pilon fracture require either ORIF or external fixation. 

Remember to complete a CT with spiral fractures involving the distal tibia, especially if they are comminuted fractures.  Posterior malleolus fracture occurs frequently with this injury and maybe missed in plain x-ray 3.   

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Case information

rID: 64937
Published: 17th Jan 2019
Last edited: 18th Aug 2019
Inclusion in quiz mode: Included

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