Pilon Fractures of the Ankle
Pilon fractures affect the bottom of the shinbone (tibia) at the ankle joint. In most cases, both bones in the lower leg, the tibia and fibula, are broken near the ankle.
Pilon is a French word for pestle, an instrument used for crushing or pounding. In many pilon fractures, the bones of the ankle joint are crushed due to the high-energy impact causing the injury. Pilon fractures may be considered high-energy ankle fractures.
Because of the energy required to cause this type of fracture, 25% to 50% of patients have additional injuries that require treatment.
Pilon fractures are most often caused by high-energy impacts, such as:
A pilon fracture often affects both bones of the lower leg.
- Fall from height
- Motor vehicle/motorcycle collisions
- Skiing
Risk Factors
- Age. The average age of someone with a pilon fracture is 35 to 40 years old. Pilon fractures are rare in children and elderly people. However, as our population ages, seniors will account for a larger amount of these fractures.
- Male. Men are three times more likely than women to have pilon fractures.
Air Bags
In recent years, there has been an increase in pilon fractures. This is due to the impact airbags have had in saving people's lives. Before there were airbags, most people did not survive high-speed car crashes. More people survive these crashes now, but because airbags do not protect the legs, there are also more leg injuries like pilon fractures.
- Immediate and severe pain
- Swelling
- Bruising
- Tender to the touch
- Cannot put any weight on the injured foot
- Deformity ("out of place")—your ankle looks angled or crooked
After discussing your symptoms and medical history, your doctor will examine your lower leg and ankle. This will include looking at your ankle and pushing on different areas to see if it hurts.
Your doctor will check for sensation and look for a pulse to make sure there is blood supply to your foot and ankle. He or she will also check for swelling, which may determine if and when surgery can be done.
Along with the physical examination, x-rays of your leg, ankle, and foot are the most common ways to evaluate your ankle. They can show whether a bone is intact or broken.
To fully evaluate your fracture, your doctor may recommend an x-ray (left), a CAT scan (center), or a three-dimensional CAT scan (right).
A computed tomography (CT or CAT) scan is commonly done to evaluate your ankle joint. This type of scan can create a cross-section image of your ankle. Your doctor may order this scan right away, or wait until after an external fixator (discussed below) is applied.