Pilon fracture

Case contributed by Dr Safwat Mohammad Almoghazy

Presentation

presented to causality with history of fall from height more than 1.5 meters and swelling over the left ankle.

Patient Data

Age: 50 years
Gender: Male

Severe distal tibial comminution fracture and extension through the dome of the tibial plafond.

  • medial malleolus shows comminuted fracture reaching to the tibiotalar articular surface.
  • lateral malleolus shows mildly displaced transverse fissure fracture reaching to the fibulotalar articular surface.
  • dense bone island is noted at the talar neck.

Case Discussion

This is an excellent example of Pilon fracture type III  according to the Ruedi and Algower classification,  fractures of the distal tibia involving the tibial plafond.

The Pilon fractures occur as a result of the impact of the talar dome during acute axial loading mechanism as our case.

The distinction between the pilon and trimalleolar fractures carries important surgical and prognostic implications.

This distinction is best made by correlating the clinical mechanism of the injury with the four characteristic radiographic criteria that distinguish the two types of fractures.

Four major radiographic criteria distinguish pilon fractures from trimalleolar fractures:

  1. extensive comminution of the distal tibia with the circumferential distribution of fracture fragments
  2. the presence of intraarticular fracture into the dome of the tibial plafond
  3. the presence of a talar fracture in some pylon injuries
  4. anatomic relationship of the lateral malleolus to the talus at the level of the ankle mortise. This relationship is best appreciated at CT

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