Review articlePilon Fractures: Assessment and Treatment
Section snippets
Anatomy
The relatively thick-walled cortical bone of the tibial diaphysis flares distally at the transition of the diaphysis to metaphysis. The cortex is much thinner here and the metaphysis is filled with trabecular bone. The anteromedial surface of the distal metaphysis is concave with a radius of curvature of approximately 20 cm and internally rotated 25° with respect to the posterior tibia.21 This torsion is more extreme proximally than distally and is more pronounced anteriorly than posteriorly.
Mechanism of Injury
Fractures of the tibial plafond are believed to result from either axial compression or torsion of the leg. Fractures resulting from axial compression are often the result of high-energy trauma and often have several displaced articular fragments, comminution of the metaphyseal bone, and soft tissue injury. In these types of injuries, it is common that the fibula is also fractured. These injuries commonly occur when individuals fall from a height, are involved in a motor vehicle crash, or
Fracture Classification
Effective fracture classification schemes improve communication among treating physicians, provide insight into injury prognosis, and help guide treatment. The classification proposed by Rüedi and Allgöwer29, 30, 31 30 years ago is still widely used today. This classification system separates the fractures into three types depending upon the amount of articular fracture displacement. Type A fractures are simple cleavage type fractures with little or no articular displacement, type B fractures
Operative Indications
The primary indications for surgical intervention of fractures of the tibial plafond are articular fracture fragment displacement of more than 2 mm, joint instability resulting from the fracture, unacceptable axial alignment of the limb, and an open fracture. The presence of a vascular injury necessitating repair to maintain viability of the foot is also an indication for operative stabilization of the fracture. The benefits of operative stabilization include anatomic reconstruction of the
Treatment Options
There are several treatment options for tibial plafond fractures that include hybrid external fixation, limited internal fixation with external fixation, percutaneous plating (generally reserved for extra-articular fractures or these with minimal intra-articular involvement), and external fixation. The method where temporary external fixation is performed and followed by formal ORIF is gaining in popularity.26, 42
Hybrid external fixation of pilon fractures has been advocated recently.1, 10, 36,
Summary
The treatment of high-energy intra-articular fractures of the tibial plafond involves many potential complications. A protocol, which includes immediate ORIF of the fractured fibula and the application of a spanning external fixator followed by delayed ORIF of the tibia, has been developed. This protocol recognizes the importance of the surrounding soft tissues and is based on sound principles and thorough clinical experience. This protocol allows the soft tissues to recover before definitive
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Cited by (65)
Traumatic Foot and Ankle Injuries
2022, Foot and Ankle BiomechanicsThe management of tibial pilon fractures with the Ilizarov fixator: The role of ankle arthroscopy
2015, FootCitation Excerpt :Pilon or tibial plafond fracture is considered one of the most difficult injuries to treat [3,4,6,15].
Finite element analysis of three commonly used external fixation devices for treating Type III pilon fractures
2014, Medical Engineering and PhysicsCitation Excerpt :These fractures are uncommon and represent up to 7–10% of tibia fractures and less than 1% of all lower extremity fractures [4,7]. The mechanism of injury varies from simple rotational fractures to high energy axial compression injuries complicated by shearing, rotation and bending forces [4,8,9]. In 1969, Ruedi and Allgower [10–16] classified the pilon fractures into three types: type I is an intra-articular fracture of the distal tibia with or without minimal displacement; type II is a displaced intra-articular fracture with or without minimal comminution; and type III has significant comminution and impaction of the intra-articular surface with displacement.
Pilon Fractures
2012, Clinics in Podiatric Medicine and Surgery