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Pilon FracturesPilon Fractures

Mohammed Nabil J AlAliMohammed Nabil J AlAli5th Year Medical StudentAt King Faisal University

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- OVERVIEW ( anatomy, definition, epidemiology and mechanisms )

- EVALUATION ( Clinical, physical and imaging )

- CLASSIFICATIONS- ASSOCIATED INJURIES- TREATMENT- COMPLICATIONS

Objectives

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ANATOMY

Talus

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ANATOMY

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What is Pilon Fracture?• Pilon is a French word for pestle ( also known as

Plafond Fracture ) .

• It is intraarticular fracture of the distal end of the tibia , involving the disruption of the distal tibial weight-bearing articular surface .

• It is different from ankle fractures .• In most cases, both bones are broken .

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EPIDEMIOLOGYEPIDEMIOLOGY• Account for approximately 5-7% of all tibia fractures.• But less than 1% of all lower-extremity fractures .• More commonly at average age of 35 to 40 years old.

rare in children and elderly.

• Commonly in men than women (3:1)• Because of the energy required to cause this type of

fracture, 25% to 50% of patients have additional injuries that require treatment.

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Mechanism Pilon fractures are most often caused by axial loading (high-

energy impacts or combination), such as : Fall from height , Motor-vehicle accident .

- Leads to ( high degree of disruption of articular surface and soft tissue affection )

It may be caused by shear loading (rotational or lower-energy impacts ) such as : Ski accident .

- Leads to ( less degree of disruption of articular surface )

Often affects both bones of the lower leg.

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EVALUATIONEVALUATION

Clinical presentation

Physical examination

Imaging

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• Signs and symptoms include an inability to bear weight , marked pain , marked

swelling , and evidence of soft tissue injury and deformity ( out of place ) .

Clinical presentation

EEVVAALLUUAATTIIOONN

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Physical examination

• Neurovascular examination include distal pulses , capillary refill , motor and sensory examination .

• Soft tissue- Closed fractures : classified using the method of Tscherne- Opened fractures : classified using the method of Gustilo .

EEVVAALLUUAATTIIOONN

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Imaging

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EEVVAALLUUAATTIIOONN

Imaging

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CLASSIFICATIONS

Association for Osteosynthesis/Orthopedic trauma association (AO/OTA) Classification

Reudi and Allgower Classification

Has good interobserver and intraobserver agreement at the type level .

Has good interobserver and intraobserver agreement at the group level

(the most important ).

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Type I Fracture involving minimal displacement

Type II Significant displacement of the joint surface

Type III Impaction and comminution of the articular surface

CLASSIFICATIONS

Reudi and Allgower Classification

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CLASSIFICATIONS

AO/OTA Classification

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ASSOCIATED INJURIES

• Other skeletal injuries

• Soft tissue injuries- open fractures

- closed fractures

• Neurovascular injuries

• Other body parts injuries

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TREATMENT and RATIONAl

Treatment goals Treatment options Bony considerations soft tissue considerations Timing of surgery

TREATMENT

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TREATMENT

Surgical( To manage displaced

fractures )

Modern methods : (ORIF) and external

fixation with or without limited internal fixation

Treatment goals - Anatomical restoration of distal tibial articular surface .- Early ankle range of motion.

Treatment options

Non-surgical( to manage

non-displaced fractures)

Cast and Splints

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Bony considerationsTibia

- Comminution - Lower energy : (ORIF)

- High energy + large number of small articulations :

external fixation with or

without limited internal fixation

- Diaphyseal extention

Typically epi and meta of fracture is heal more rapid .

Fibula

ORIF with plate and scrow

Remember the most important is restore Tibia

TREATMENT

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soft tissue considerations

Timing of surgeryDepend on soft tissue affection .

Low-energy injuries :

By ORIF

TREATMENT

High-energy injuries :

By external fixation with or without limited internal fixation

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Plates and screws An external fixatorA splint

TREATMENT

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ANATOMICAL CONSEDARATIONS AND SURGICAL TECHNIQUES

• ORIF• External fixation - Unilateral

- ilizarvo ( consists of fine wire “ 1.8mm” for interfragmentary fixation ) .

- hybird ( ring with wire distally )

• Soft tissue • LigamentotaxisWhen traction is applied across the ankle joint , the intraarticular

fragments may be reduced by pull of the capsule and ligamentous structures .

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COMPLICATIONS

• Soft tissue slough. • Infections .• Neurovascular injuries.• Bone healing problems

( Mal-alignment, Mal-union and Non-union ) .• Painful plates and screws.• Decreased ankle joint range of motion.• Chronic edema .• Posttraumatic arthritis .

Sever complications following ORIF of tibial fractures range from 10-55% and some can lead to amputation

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Any Question ?Any Question ?

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REFERENCES- Review of Orthopaedic

Trauma by Mark R.Brinker , M.D.

- AAOS (press on the title )

- Medescape (press on the title )

- UpToDate (press on the title )

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Thank you