Pilon fractures represent less than ten percent of lower extremity fractures, but rates of incidence are increasing due to advances in car safety. A pilon fracture consists of a break in the shinbone, formally called the tibia, closely to the ankle, as opposed to proximal tibial fractures near the knee. Pilon fractures result from high falls and high energy impacts such as car accidents. As life preserving technology increases the survivability of car accidents a correlation of pilon fractures have increased in incidence of treatment. Due to the large amount of force required to fracture the distal tibia often a fractured fibula accompanies the injury. The vast majority of pilon fractures receive initial treatment in an emergency room to stabilize the fracture.
Conservative treatment of a Pilon Fracture
Rarely a pilon fracture will be non-displaced or minimally displaced allowing the treating physician to simply cast or splint the fracture. Typically, a physician places you in a cast for six weeks, evaluates you, and switches you to a removable splint for hygienic convenience. However, after removing the cast the patient must not bear weight for at least 12 weeks for the fracture to heal properly. You physician monitors your progress and well let you know when it is okay to start placing weight on the leg.
Surgical Treatment of a Pilon Fracture
ORIF surgery, or Open Reduction Internal Fixation, surgically opens the fracture site to place the bones back into proper alignment and utilizes plates and screws to hold the bones in place as they heal. Surgeons can’t always treat a pilon fracture immediately due to risk of infection and may have to wait for the swelling to go down or for the skin to heal. In cases where surgery must wait a physician may use a cage, called an external fixator, placed around the fracture to support metal rods inserted into the local bones to support the fracture until ready for surgical correction. Sometimes it takes multiple surgeries to correct a pilon fracture; the first surgery to correct the fracture and then a second surgery later to rebuild the proper function of the ankle joint.
Recovery from a Pilon Fracture
Recovery from a pilon fracture takes three to four months before a patient can put their full weight on their leg. The physician removes the cast after about six weeks and replaces it with a removable splint so the patient can begin physical therapy. Many patients require a walking aid for up to four months before bearing full weight.