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The Causes, Symptoms And Treatment Options For Pilon Fractures

A pilon fracture is a rare and complex bone break that occurs at the top of your ankle joint. The fracture requires a significant amount of force and oftentimes involves injuries to two or more bones in the ankle joint complex. It takes a skilled foot specialist to help a person make a full recovery after a pilon fracture, but Dr. McDonald is confident that he can help restore function in the ankle if you are ever unfortunate enough to suffer the injury. Below, we explore the causes, symptoms and treatment options for pilon fractures of the ankle.

Understanding Pilon Fractures And Their Symptoms

The pilon fracture gets its name from the French language. In French, pilon is the word for pestle, which is a rounded tool that is used to crush and grind substances into powder. With this image in mind, let’s take a closer look at the mechanism behind a pilon fracture.

Two long bones in your leg, the tibia and fibula, attached to your talus, which is the weight-bearing bone at the top of your ankle complex. During a pilon fracture, your talus is driven upwards with such force that it grinds/crushes/fractures the lower part of your tibia and oftentimes your fibula. Your talus acts similarly to a pestle in that it overloads the bones above it, causing them to fracture.

As you can imagine, it takes a significant force for the talus to act as a pestle towards your tibia and fibula. The two most common causes of pilon fractures are from motor vehicle accidents and falls from a great height where the individual lands on their feet. If you come to an abrupt stop and that stress is applied to your feet, it can force your talus back into the base of your tibia and fibula with great force.

While you may not know that you are specifically dealing with a pilon fracture, it will be obvious that there is a major issue in your ankle and leg area if you indeed are suffering from a pilon fracture. Symptoms tend to be severe and include:

  • Pain
  • Inability to bear weight
  • Bruising
  • Swelling
  • Visible deformity

About 20 percent of pilon fractures are open fractures, meaning that part of a bone ends up breaking through the skin. Again, this will clearly showcase that you are dealing with a significant injury, and immediate medical attention is necessary to address the fracture and control infection risk.

Treating Pilon Fractures

Pilon fractures are typically managed based on their significance, and to better understand the impact of the foot trauma, these fractures are usually categorized into one of three types:

  • Type I – A type I pilon fracture involves an articular fracture with minimal or no bone displacement.
  • Type II  – A type II pilon fracture occurs when the tibia is displaced, but there is minimal or no bone comminution (fragmentation).
  • Type III – A type III pilon fracture is the most severe type of pilon fracture. It involves bone comminution and impacted fracture patterns to the tibia and fibula. Roughly half of all pilon fractures are type III.

If your fracture isn’t displaced and your doctor believes that the bones stand a good chance of healing properly on their own, they may recommend a combination of conservative techniques, including rest, bracing/casting, medications and physical therapy. It is not uncommon for the patient to be non-weightbearing for the first 12 weeks of recovery, and full recovery can take 6-12 months.

For more severe fractures, or for ones where the doctor doesn’t believe healing will occur well on its own, surgical intervention may be the right course of care. Two main procedures used to address a pilon fracture are an open reduction with internal fixation, where the broken bones are realigned and held in place with surgical hardware, or an external fixation, where metal pins are inserted into the bone and attached to an external frame for support and protection. This procedure is typically performed until enough healing takes place that the more standard open reduction and internal fixation procedure can take place. Recovery after surgery follows a similar pattern, with weeks of non-weightbearing followed by gradual stress and physical therapy. It can take six months to get back to normal activities, but a complete recovery can take up to a year or longer.

Hopefully you never need to recover from a pilon fracture, but if you do, Dr. McDonald and his team are here to help. For more information, or for help with a different foot or ankle issue, reach out to our office today at (860) 244-8889.

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