Complex Fractures (Pilon C3, SER-4, PER-4)

Home Complex Fractures (Pilon C3, SER-4, PER-4)

Pilon fractures are challenging to manage because of the complexity of the injury pattern and the risk of significant complications. The soft tissue injury and handling of the soft tissue envelope are crucial in pilon fracture outcomes.

A pilon fracture is a type of break that occurs at the bottom of the tibia (shinbone) and involves the weight-bearing surface of the ankle joint. With this type of injury, the other bone in the lower leg, the fibula, is frequently broken as well. A pilon fracture typically occurs as the result of a high-energy event, such as a car collision or fall from a height. Pilon fractures are often severe injuries that can permanently affect the ankle joint.


Patients with pilon fractures usually experience immediate and severe pain. Other symptoms may include:

  • Swelling
  • Bruising
  • Tenderness
  • Inability to bear weight on the injured leg
  • Deformity—your ankle may look angled or crooked


Pilon fractures most often result from high-energy trauma such as a car or motorcycle accident, fall from a height, or skiing accident.

Doctors have seen an increase in pilon fractures since the introduction of air bags in motor vehicles. While air bags enable more people to survive high-speed car crashes, they do not protect the legs—so many of the survivors wind up with pilon fractures and other leg injuries.


Nonsurgical Treatment

  • Splints and casts. In most cases, your doctor will first apply a splint to hold your ankle in place. Once the swelling goes down, he or she will replace the splint with a short leg cast. To provide effective support, your cast must correctly fit your ankle. For this reason, as the swelling in your ankle decreases, you may need frequent cast changes.
  • Monitoring. Your doctor will closely monitor the healing of your fracture. During this time, you will need to return regularly for follow-up x-rays to make sure your ankle remains stable.
  • Recovery. You will most likely be unable to bear weight on your ankle for up to 12 weeks after your injury. During this time, your doctor may recommend that you use crutches or a walker. After 6 weeks, your doctor may replace your cast with a removable brace. This will offer protection while your ankle continues to heal.

Surgical Treatment

Surgery is commonly recommended for unstable fractures in which the bones are out of place.