Fractures of the Pilon

Definition

A tibial plafond fracture (also called tibial pilon fracture) occurs at the bottom of the shin bone (tibia), and involves the ankle joint. This fracture occurs when the talus, the key central bone in the ankle, is forced up into the tibia causing the bone to break through or near the joint (articular) surfaces.

This can occur in a few situations, but an easy one to visualise is a fall onto the feet that smashes the leg straight down, crushing the bones against each other. Fortunately, tibial plafond fractures are relatively rare.

Tibial plafond fractures are divided broadly into

  • low energy injuries, for example skiiing, where the ankle is twisted or compressed, or osteoporotic type fractures in the elderly,
  • or high energy injuries, as in falls from a height or motor vehicle accidents.

For a tibial plafond fracture to occur, a great deal of force is usually required, and for this reason there are often secondary injuries to the fibula, pelvis and spine and occasionally the internal organs. 

When a fracture occurs into or around a joint surface, that joint is at high risk of developing arthritis due to the injury. Unfortunately, even if the bone and cartilage surfaces are lined up perfectly, there is still a risk of developing arthritis due to injury to the cartilage cells.

These fractures are concerning for two reasons:

  • Swelling and skin problems. Near the ankle, the shin bone (tibia) is not covered by much muscle or other soft tissues. Because of this, swelling can be a significant problem. Plafond fractures often require surgery, which can be compromised due to skin problems such as infection or poor wound healing.
  • Arthritis. The fracture line often extends into the cartilage of the ankle joint. Because of this, the ankle is prone to developing arthritis due to uneven bone surfaces and damage to the cartilage cells.

This injury is seen in motor vehicle accidents, skiing accidents and after falling from a height on your feet.

This fracture is an emergency and requires urgent treatment that includes

  • alignment and splintage
  • elevation of the leg
  • use of ice and anti-inflammatory medication (eg nurofen)

These measures help in reduction of pain and swelling and minimise the chances of skin breakdown.

19 August, 2011