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.

Pilon is the French word for “pestle”—an instrument used for crushing or pounding. In many pilon fractures, the bone may be crushed or split into several pieces due to the high energy impact that caused the injury.

In most cases, surgery is needed to restore the damaged bone to its normal position. Because of the energy required to cause a pilon fracture, patients may have other injuries that require treatment as well.

Cause

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.

Symptoms

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

Treatment

Many pilon fractures require surgery but, rarely, some stable fractures can be treated nonsurgically. Whether or not your doctor recommends surgery often depends on how out of place (displaced) the fractured pieces of bone are.

Nonsurgical Treatment

Nonsurgical treatment may be recommended for stable fractures in which the pieces of bone are not displaced or are minimally displaced.

It may also be recommended for patients who are unable to walk or patients with very serious medical problems who may not be able to tolerate surgery.

Nonsurgical treatment may include:

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.

Open Reduction and Internal Fixation
During this operation, the displaced bone fragments are first repositioned (reduced) into their normal alignment, and then held together with screws and metal plates attached to the outer surface of the bone.

Timing of Surgery
If you have significant swelling or blisters, your doctor will delay your surgery until the swelling goes down. Performing surgery too soon increases your risk for infection or problems with your incision. Your surgery may be delayed for up to 2 weeks or more, depending on how long it takes for the swelling to go down.

Your doctor may place your ankle in a splint until your surgery, or recommend that you have an initial smaller surgery to protect your ankle while waiting for the second surgery.