Pilon Fractures

It seems we've had a rash of pilon fractures come through lately and it prompted me to share here. Really this is something the ortho guys love, but as well all know ortho and trauma work pretty closely together. So first off, what's a pilon fracture? It's a comminuted fracture of the distal tibia that usually occurs from vertical/axial loading which drives the talus into the distal tibia. It generally seems that the axial loading mechanism we see is a jump from a height. There are probably a multitude of ways to break your distal tibia other than a jump. A motor vehicle crash is another frequent method.

The picture above is lateral x-ray of a pilon fracture and the picture to below is an A/P (anterior/posterior) view. Treatment can be either non-op or operative repair, and I generally see the Ortho guys go for operative fixation. This, of course, depends on age, comorbidities, and all the other factors that go into deciding if a patient is a surgical candidate. Nonetheless, they are practically always splinted and made non-weight bearing. Bone union usually occurs in 2-3 months. Apparently it's reported that those without surgical complications can expect about a 75% chance of a good outcome, yet I think clinically I see it higher than 75%.


When the mechanism is a low-energy impaction, it's not uncommon to find this as an isolated injury, or at least limited to the ipsilateral extremity. This tends to be the case for the jumps I mentioned, but those can also include bilateral extremity injuries and back injuries if it was from a descent height. A motor vehicle crash would be a high-velocity impaction and then you can certainly have a whole host of other problems. This could be to the extent that the pilon fracture is now small potatoes compared to the chest, abdomen, or head injuries that are immediately life-threatening. But it's always good to give a shout out to the bones too.