Pilon fractures occur at the lower end of the tibia, or the shinbone, where the part of the bone near the ankle bears the most weight. The smaller calf bone on the lateral side of the tibia, the fibula, most often is broken as well following the fracture.
Usually occurring in adults aged 30-40s, this injury is rare, consisting of only 7% of tibia fractures. It may be difficult to treat and complications after treatment are common.
Pilon fractures are usually resulted from high-impact falls or car accidents. Airbags in cars can save a person’s life but not protect the legs. Thus in a collision, survivors may sustain pilon fractures and usually other forms of injuries.
Patients would feel severe pain with swelling and bruising. Walking is impossible or extremely difficult. Bearing weight on the injured foot at this point would cause the bones and soft tissue to be further damaged. The ankle would also have a deformed appearance because of the displaced bones.
It is important to inform your doctor the way that you got yourself hurt to gauge the severity of the injury. Your doctor may do an X-ray, radiograph, CT scan or 3D CAT scan to fully evaluate the fracture. Whether surgery is opted for also depends on the patient’s health condition. Let your doctor know about your medical history to avoid the risk of aggravating your health issues.
The decision to go for surgery depends on the extent of the displacement. Most pilon fractures require surgery. If the bones are minimally displaced, nonsurgical treatment might be possible.
Cast immobilization is used for fractures with bone pieces still aligned and stable. Patients with health problems or do not need to do a lot of walking may also be recommended nonsurgical treatment. Cast has to be worn for 6 weeks and replaced with a brace after. It is recommended to not bear weight on the injured foot for 12 weeks.
There might be a chance that patient is left with a deformed-looking ankle after the fracture heals. Improper care during the recovery process or complications cause incomplete alignment. If the shape of the joints is not fully restored, patient is at a high risk of developing arthritis.
Metal implants such as plates and screws are used in open reduction and internal fixation to hold the bones back in place. However, if the swelling and blisters are too severe, an external fixator may be applied first to stabilize the bones and allow soft tissue to heal before the surgery can take place to reduce the risk of infection.
Full recovery typically takes 3-6 months with regular follow-ups. Physical activity should be kept to the minimal during this period to prevent jeopardizing the healing process. It is not uncommon that patients may take up to 12 months to fully recover and regularly experience stiffness, swelling and aches even after recovery. Physiotherapy might be needed for patients that take longer to heal.