Distal Tibia(Pilon) Fractures
The tibia and fibula are long shin bones, which articulate with the thigh bone on one end and ankle joint at the lower end. The part of the tibia that articulates with the talus (ankle bone) is called the tibial plafond or pilon. Fractures of the tibial plafond are rare, occurring as a result of a fall from a height or a motor vehicle accident that forces the ankle up against the tibia, often causing the bone to shatter. The fracture is often accompanied by damage to soft tissue, articular cartilage and underlying bone, which can lead to post-traumatic arthritis.
Tibial plafond or pilon fractures are usually accompanied by pain, swelling, deformity and inability to bear weight. The fractured bone may disrupt the skin, resulting in an open fracture, which needs to be treated emergently due to the possibility of infection.
When you present to the clinic with a pilon fracture, your doctor performs a physical examination of the area of injury for disruption of skin, and to assess nerves and blood supply. X-rays and a CT scan of the ankle are ordered. Imaging studies of the fibula, spine and hip are also ordered to check for associated injuries.
Emergency treatment includes irrigation of the open wound and administration of antibiotics to control infection. Pain and swelling is controlled with medication, ice application, elevation of your foot or application of a temporary splint. Your doctor may treat a tibial plafond fracture by nonsurgical methods with a cast or splint for 10 to 12 weeks, if the fracture is not displaced or your health does not permit surgery. Your fracture may be externally stabilized in a frame if there is significant soft tissue injury to allow the tissues to heal.
Surgery is indicated for most tibial plafond fractures after the swelling has subsided. It is performed through one or more incisions and involves placing the fractured tibial plafond back in its anatomic position and stabilizing it with screws and plates. If a fibula fracture is present, it is also repaired. If arthritis develops at a later stage, you may require a procedure called arthrodesis which involves fusion of the bones in the ankle.