Pilon Fracture

ICD-9	Classification / Treatment / ORIF / Ex Fix
Etiology / Epidemiology / Natural History	Associated Injuries / Differential Diagnosis
Anatomy	Complications
Clinical Evaluation	Follow-up Care
Xray / Diagnositc Tests	Review References

synonyms: Tibial Plafond Fracture,

Pilon Fracture ICD-9

• 823.80(closed fracture of unspecified part of tibia)
• 823.81(closed fracture lower leg NOS; fibula alone)
• 823.82 (closed fracture lower leg NOS; fibula with tibia)
• 823.90(open fracture of unspecified part of tibia)
• 823.91(open fracture of unspecified part fibula alone)
• 823.92 (Unspecified part, open, fibula with tibia)

Pilon Fracture Etiology / Epidemiology / Natural History

• Pilon fractures are fractures involving the articular weight bearing surface of the distal tibia.
• Usually high energy axial load (MVC, fall from height), occasionally low-energy rotation/torsion
• Foot postion determines fracture pattern: if plantar flexed = posterior tibial fragment, neutral = entire articular surface, dorsiflexed=anterior fragments
• 7-10% of tibial fractures

Pilon Fracture Anatomy

• Distal tibia fractures within 5cm of the ankle

Pilon Fracture Clinical Evaluation

• Assess vascularity by evaluating dorsalis pedis and posterior tibial pulses as well as distal capillary refill
• Evaluate soft tissues. Open fracture classification.

Pilon Fracture Xray

• A/P, lateral and mortise views of the ankle; A/P, lateral tibia films
• CT scan indicated for pre-op planning,  CT scans should be done in traction with 3D reconstructions.

Pilon Fracture Classification/Treatment

• Soft tissues injuries are classified according to Tscherne and Gotzen.
• Open fracture classified per Gustilo and Anderson.
• Principles of Treatment: restoration of fibular length, anatomic reduction of tibial articular surface, bone grafting of metaphyseal defects, medial buttress plating to prevent varus
• Treatment: initial fixation of the fibula with temporary spanning external fixation with delayed conversion to internal fixation when soft tissues permit, generally 14-21 days. See Pilon ORIF / Ex Fix Technique.
• closed fractures should be placed in calcaneal traction and a Bohler-Braun frame.
• open fractures/compartment syndromes should be taken to OR for 2-pin traveling traction. (one 6mm centrally threaded calcaneal pin and one proximal tibia pin at level of the fibular head with quadrilateral frame.
• AO comprehensive Classification of Fractures of long Bones
• Ruedi Allgower Classification (Ruedi TP, Allgower M CORR 1979;138:105).
• Type A=extra-articular=@92% good/excellent results, Type B=partial articular=@85% good/excellent results, Type C=complete articular=@60% good/excellent results
• poor results associated with high-grade soft-tissue injury, >2mm articular incongruency, malalignment of mechanical axis >5degrees
• Reudi-Allgower Classification: Type I & II = 86% excellent to good results nonuniomn =7%, malunion=3%, wound dehiscence=17% Type II&III high energy=wound problems and deep infection uto 37%, malunion=23%, nonunion=27%.  Tscherne grades 0 or 1 best treated with AO/ASIF technique plating, femoral distractor often helpful for indirect reduction.
• Tsherne 2 & 3 and open fx best treated with limited open fixation(olive wires/canulated screws) for articular reduction and small wire circular external fixation.
• AO Classification