Pilon Fracture

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Physical Therapy Videos - Foot & Ankle

What Is It?

An ankle break, called a pilon fracture, is an injury to the ankle joint. The ankle is made of the tibia (shin bone), talus bone, and fibula (outside ankle bone). These bones have cartilage, a smooth surface that helps the ankle move easily. Ligaments connect the bones together. Blood vessels, nerves, and muscles are also part of the ankle.

Skeleton model of front and side view of the ankle.
Figure 1: Skeleton model of front and side view of the ankle.

 

X-rays showing normal ankle anatomy.
Figure 2: X-rays showing normal ankle anatomy, highlighting the relationship of the shin bone (tibia), outer anklebone (fibula), and talus.

How It Happens

A pilon fracture is a break at the end of the shin bone. It can be a small crack or many broken pieces. This break usually happens after falls, car accidents, or work accidents. The talus bone pushes into the tibia and fibula, causing the break.

Front view of skeleton model with pilon area highlighted.
Figure 3: Front view of skeleton model with pilon area highlighted in red.

 

X-rays of side and front view of a pilon fracture
Figure 4: X-rays of side and front view of a pilon fracture. The fracture includes the small leg bone (fibula) and the end of the shin bone (tibia).

First Steps

After a pilon fracture, it will hurt a lot and look crooked. You'll need to go to the emergency room. Doctors will take x-rays and maybe set the bones. They'll put your leg in a splint and you can't walk on it. You might need surgery to hold the bones in place. An external fixator may be used to hold the bones in place. This lets the swelling go down before a bigger surgery to fit the bones.

X-ray of early treatment of a pilon fracture.
Figure 5: X-ray of early treatment of a pilon fracture. The outer leg bone (fibula) has been fixed with plates and screws. The shin bone has been moved and held in place with pins and bars (external fixator).

 

Photos of external fixators on ankles.
More photos of external fixators on ankles.
Figure 6: Examples of external fixators on ankles.

Treatment

Your doctor will decide if you need surgery. It can take several cuts to fix the bones correctly. There needs to be minimal swelling in the ankle before this can be done. Your surgeon may use bone from a different area or a cadaver to replace your missing or destroyed bone. Most ankle breaks take 6 to 12 weeks to heal. After that, you'll slowly start walking more. You might need physical therapy to help with movement and walking.

X-rays of front and side view following surgery to fix a pilon fracture.
Figure 7: X-rays of front and side view following surgery to fix a pilon fracture. Both the smaller fibula and the shin bone (tibia) were fixed with plates and screws.

Recovery

You can't put weight on your leg for weeks after the break. You might need crutches or a wheelchair. You'll wear a splint or brace for at least 2 weeks. After that, you may get a cast or another brace. Your rehab team might let you move your ankle soon after surgery. Be sure to follow your surgeon's instructions.

Long Term

Ankle breaks can cause arthritis, which might take years to develop. Patients might have stiffness, pain, and trouble walking. They might need braces or more surgery. An ankle break can cause long-term problems and pain. You might need more surgery or, in extreme cases, an amputation. If you stand or walk a lot at work, an ankle break will affect your life. You may need a job change or help with walking and standing.

X-rays of front and side views of a pilon fracture one year after surgery.
Figure 8: X-rays of front and side views of a pilon fracture one year after surgery. Due to the original injury, the ankle joint has no cartilage left (osteoarthritis).

 

X-rays of front and side view of an ankle after a total ankle replacement.
Figure 9: X-rays of front and side view of an ankle after removing the plates and treating the arthritis with a total ankle replacement.

 

Physical Therapy Videos - Foot & Ankle

More Information

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Eric Magnuson, MD, and Christopher Domes, MD
Edited by the OTA Patient Education Committee
X-rays and images from the personal collections of Dr. Magnuson, Dr. Domes, and Matthew Hogue, MD