Pilon fracture

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Pilon fracture
Other namesPlafond fracture
Pilon fracture xray.jpg
X-ray of a fracture involving the articular surface of the Tibia
Specialty Orthopedic surgery  OOjs UI icon edit-ltr-progressive.svg

A pilon fracture, is a fracture of the distal part of the tibia, involving its articular surface at the ankle joint. Pilon fractures are caused by rotational or axial forces, mostly as a result of falls from a height or motor vehicle accidents. Pilon fractures are rare, comprising 3 to 10 percent of all fractures of the tibia and 1 percent of all lower extremity fractures, but they involve a large part of the weight-bearing surface of the tibia in the ankle joint. Because of this, they may be difficult to fixate and are historically associated with high rates of complications and poor outcome. [1] [2] [3] [4]

Contents

Pilon is the French word for "pestle" and was introduced into orthopedic literature in 1911 by pioneer French radiologist Étienne Destot. [1]

Classification

Pilon fractures are categorized by two main X-ray schemes, Ruedi-Allgower classification system. [4] and Müller AO Classification of fractures. [5]

Treatment

The treatment of pilon fractures depends on the extent of the injury. This includes the involvement of other bones such as the fibula and the talus, involvement of soft tissue, and the fracture pattern. Treatment strategies and fixation methods used include internal and external fixation, as well as staged approaches, with the aim of reducing the fracture, reconstructing the involved bones and restoration of articular surface congruence, with minimal insult to soft tissues. [4] [6] Appropriate wound management is important to reduce the high rate of infectious complications and secondary wound healing problems associated with open pilon fractures. [7] Vacuum-assisted wound closure therapy and using a staged protocol (awaiting soft-tissue recovery before extensive reconstructive efforts) may play a positive role. [7]

See also

Related Research Articles

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<span class="mw-page-title-main">Mandibular fracture</span> Medical condition

Mandibular fracture, also known as fracture of the jaw, is a break through the mandibular bone. In about 60% of cases the break occurs in two places. It may result in a decreased ability to fully open the mouth. Often the teeth will not feel properly aligned or there may be bleeding of the gums. Mandibular fractures occur most commonly among males in their 30s.

The Gustilo open fracture classification system is the most commonly used classification system for open fractures. It was created by Ramón Gustilo and Anderson, and then further expanded by Gustilo, Mendoza, and Williams.

<span class="mw-page-title-main">Crus fracture</span>

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<span class="mw-page-title-main">Tibial plateau fracture</span> Medical condition

A tibial plateau fracture is a break of the upper part of the tibia (shinbone) that involves the knee joint. Symptoms include pain, swelling, and a decreased ability to move the knee. People are generally unable to walk. Complication may include injury to the artery or nerve, arthritis, and compartment syndrome.

<span class="mw-page-title-main">Tibia shaft fracture</span> Medical condition

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References

  1. 1 2 Mandi, DM; Belin, RP; Banks, J; Barrett, B (Apr 2012). "Pilon fractures". Clinics in Podiatric Medicine and Surgery. 29 (2): 243–278, viii. doi:10.1016/j.cpm.2012.01.001. PMID   22424487.
  2. Liporace FA, Yoon RS (August 2012). "Decisions and staging leading to definitive open management of pilon fractures: where have we come from and where are we now?". J Orthop Trauma. 26 (8): 488–98. doi:10.1097/BOT.0b013e31822fbdbe. PMID   22357091.
  3. Crist, BD; Khazzam, M; Murtha, YM; Della Rocca, GJ (Oct 2011). "Pilon Fractures: Advances in Surgical Management". The Journal of the American Academy of Orthopaedic Surgeons. 19 (10): 612–22. doi:10.5435/00124635-201110000-00005. PMID   21980026. S2CID   26549436.
  4. 1 2 3 Rayan, A; Kotb, A; Elmoatasem, EM; Samir, S; EL-Sobky, TA; El-Hawi, E; Mahran, M (17 April 2018). "Open reduction internal fixation versus external fixation with limited internal fixation for displaced comminuted closed pilon fractures: A randomised prospective study". Journal of Orthopaedics, Trauma and Rehabilitation. 24: 84–89. doi: 10.1016/j.jotr.2017.08.001 .
  5. Jacob N, Amin A, Giotakis N, Narayan B, Nayagam S, Trompeter AJ (November 2015). "Management of high-energy tibial pilon fractures". Strategies Trauma Limb Reconstr. 10 (3): 137–47. doi:10.1007/s11751-015-0231-5. PMC   4666229 . PMID   26407690.
  6. Calori GM, Tagliabue L, Mazza E, de Bellis U, Pierannunzii L, Marelli BM, Colombo M, Albisetti W (Nov 2010). "Tibial pilon fractures: which method of treatment?". Injury. 41 (11): 1183–90. doi:10.1016/j.injury.2010.08.041. PMID   20870227.
  7. 1 2 Tarkin, IS; Clare, MP; Marcantonio, A; Pape, HC (Feb 2008). "An Update on the Management of High-energy Pilon Fractures". Injury. 39 (2): 142–54. doi:10.1016/j.injury.2007.07.024. PMID   18054017.