Aim; to evaluate the effect of rehabilitation exercises program on Pilon fracture outcome. 2013 Oct;34(10):1421-6. doi: 10.1177/1071100713491561. Other fractures involving the roof of the ankle joint may be called "pilon fractures," but have a better prognosis because the compressive force is coupled with torsional forces. Furthermore, the complex anatomy and trauma to the cartilage at the time of injury predispose pilon fractures to poor functional outcomes and high rates of posttraumatic arthritis. Type I Ruedi-Allgower fractures are defined as nondisplaced “cleavage fractures” of the tibial plafond. 1973 Nov;5(2):130-4. This review will discuss the recent developments in the treatment of tibial pilon fractures. These fractures account for approximately 1% to 10% of the lower leg or tibial fractures and are often associated with severe bone comminution and soft tissue compromise. Epub 2013 May 29. Login to view comments. Ankle joint reconstruction by circular frame external fixator for a severely comminuted and contaminated open tibial pilon fracture (AO 43-C3.3). Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. 2011 Aug;77(4):432-40. Tibial pilon fractures remain difficult to treat for even the most skilled orthopedic trauma surgeons.  |  Clipboard, Search History, and several other advanced features are temporarily unavailable. Keywords Pilon fractures Tibial plafond fractures Intra-articular ankle fracture Orthopedic trauma Distal tibial fractures Foot and ankle trauma Posterior pilon fracture is a common type of intraarticular fracture encountered in clinical practice. Novel anterior curved incision combined with MIPO for Pilon fracture treatment. 2004 Mar;25(3):149-50. Many pilon fractures occur due to high energy injuries such as motor vehicle accidents, falls from a height, or high-velocity sports injuries such as falling when skiing.  |  The treatment of this fracture pattern has been increasingly reported. By The Event 2015 FEATURING Patrick Yoon. Acta Chir Orthop Traumatol Cech. Biomechanics of Osteoporotic Fracture Fixation. Gitajn IL, Slobogean GP, Henderson ER, von Keudell AG, Harris MB, Scolaro JA, O'Hara NN, Elliott JT, Pogue BW, Jiang S. J Biomed Opt. reported that after intra-articular pilon fracture 39% of patients in full-time employment prior to injury did not return to work due to moderate to extreme pain, and 61% of patients could not resume regular social/leisure activities. The vascular supply of the tibial plafond derives from branches of the anterior tibial, posterior tibial, and peroneal arteries. USA.gov. In: StatPearls [Internet]. This site needs JavaScript to work properly. Pilon fractures are caused by rotational or axial forces, mostly as a result of falls from a height or motor vehicle accidents. NIH In most cases, to restore your damaged bone to its normal position, surgery is required. 2014 Jul;28(7):828-31. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. That is kept on for 2-5 weeks until the soft tissue is in better condition. Please enable it to take advantage of the complete set of features! Multi-part fractures commonly occur at the distal tibial articular surface because the energy is concentrated on the tibia. The analysis of the variables, affecting outcome in surgically treated tibia pilon fractured patients. Note the full-thickness soft tissue flaps…, Radiographs and CT scan demonstrate a partial articular pilon fracture. The Prognosis on Pilon Fracture Treatment and Recovery Immediately stabilize anyone suffering a high-energy pilon fracture. Pilon fractures have a 2 stage procedure for treatment. Epub 2013 Jul 18. A pilon fracture involves the distal tibial metaphysis with extension… COVID-19 is an emerging, rapidly evolving situation. 2019 Aug;43(8):1939-1950. doi: 10.1007/s00264-019-04344-8. Purpose of review: Here, distal K-wires used for temporary stabilization of the articular segments also act as retractors to minimize soft tissue handling, Radiographs and CT scan demonstrate a partial articular pilon fracture. Pilon fractures are of great challenges to most orthopedic traumatology surgeons because of their complexities and varieties. 2014 Oct;31(4):547-64. doi: 10.1016/j.cpm.2014.06.002. Dual incisions with…, A complete articular tibial plafond fracture managed using staged protocol with an ankle…, The sequence of reduction and fixation for a C-type pilon fracture, from left…, NLM Ankle arthritis occurs in up to 40% of people with pilon fractures. When it does enter the ankle joint, it normally does so posteriorly or medially. These fractures account for approximately 1% to 10% of the lower leg or tibial fractures and are often associated with severe bone comminution and soft tissue compromise. TECHNICAL ADVANCE Open Access Novel anterior curved incision combined with MIPO for Pilon fracture treatment Dankai Wu1, Chuangang Peng1, Guangkai Ren1, Baoming Yuan1 and He Liu1,2* Abstract Backgrounds: Poor prognosis was reported for complex Pilon fractures … In addition, your surgeon will take X-rays of your leg and ankle to see how badly the tibia and fibula are broken. “Pilon,” the French word for pestle, was first used by Etienne Destot in 1911 as an analogy for the mechanical function of the distal tibia on the talus. High energy axial loading injury that drives tibial plafond (French for ceiling) into talar dome These were felt to occur from rotational forces on the distal tibia, resulting in less comminution, fracture displacement, and soft tissue damage compared to … It is therefore useful to explore the evolution of different treatment strategies in an effort to reconstruct the axial alignment and articular surface, while minimizing additional damage to the surrounding soft tissues. 2013 Oct;44(10):1270-4. doi: 10.1016/j.injury.2013.06.016.  |  eCollection 2019. Copyright © 2020, StatPearls Publishing LLC. Fractures of the distal tibial plafond are also termed pilon fractures to describe the high energy axial compression force of the tibia as it acts as a pestle, driving vertically into the talus. NIH Lastly, the medial column was restored and buttressed using a low-profile scallop plate. Recent findings: Historically, surgical management of pilon fractures has been associated with high rates of complications, including wound complications, infections, nonunions, and even the need for amputation. applying the 3D printing technology to the pilon fracture … -, Jacob N, Amin A, Giotakis N, Narayan B, Nayagam S, Trompeter AJ. Approaches to Treating Pilon Fractures. Stephen Sems. However, recent studies have called this into question, demonstrating low wound complications with early definitive fixation. The first stage is usually an external fixator to hold the fracture out to length and in better reduction. eCollection 2019 Oct. Biomed Res Int. Commonly, the fibula bone in the ankle is broken as well. NLM 13:51. These injuries are low-velocity in nature that create an oblique or spiral fracture pattern of the distal tibia that may or may not enter the ankle joint. A pilon fracture is a type of distal tibial fracture involving the tibial plafond. The bones may be broken in multiple places. This injury occurs as the result of a high-energy vertical axial loading (e.g., fall from height, motor vehicle crash) with impaction of the talus onto the tibial plafond, resulting in a long oblique distal metaphyseal tibia fracture, as well as fracture of the tibiotalar articular surface. Tibial plafond, or pilon, fractures can be some of the most difficult fractures to manage. This topography is designed to maximize the articular surface area with the dome of the talus and minimize the stress on the ankle joint. Harada S, Teramoto T, Takaki M, Asahara T, Katoh N, Takenaka N, Matsushita T. Trauma Case Rep. 2019 Jul 29;23:100234. doi: 10.1016/j.tcr.2019.100234. An incision is made along the anterior border of the fibula, and dissection was carried out both anterior and posterior to the fibula, providing access to the fibula and anterolateral tibia, An anterolateral approach to the distal tibia. This article does not contain any studies with human or animal subjects performed by any of the authors. Research hypothesis; the outcome of study group patients will be better than the outcome of control group. Click here to Login. In Ruedi and Allgower’s initial publication, type-I fractures were associated with the highest rate of satisfactory reduction using closed methods. Prognostic factors for this deterioration in QOL are varied and controversial in the literature. Skin wrinkles returned 7 days post injury (copyright by AO Foundation, Switzerland), Various intervals that can be used to approach the distal tibia. -. Rotational pilon fractures present an entirely different fracture confi guration and long term prognosis. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Seventeen patients with Pilon fractures were enrolled in this retrospective … These can … Additional research has been focused on alternative methods of managing these complex, and sometimes non-reconstructable, injuries with the use of external fixation, minimally invasive internal fixation, and primary arthrodesis. Injury. First, the articular surface was reduced and provisionally stabilized with K-wires and an independent lag screw. 2020 Aug;25(8):080601. doi: 10.1117/1.JBO.25.8.080601. The distal tibia has a quadrilateral cross-sectional shape and together with the fibula, ligaments, and capsule, forms the ankle mortise. doi: 10.1097/00005131-200409001-00005. A pilon fracture typically occurs as the result of a high-energy event, such as a car collision or fall from a height. Clin Podiatr Med Surg. These fractures involve the … 2014. Epub 2014 Aug 3. Additional studies are evaluating adjuvants to minimize wound complications, including the use of vancomycin powder and oxygen supplementation, while another study challenges the 7-cm myth regarding the distance needed between skin incisions. Isolated fractures of the bones that have minimal to no disruption of the joint surface have an excellent long-term prognosis provided that there is excellent anatomic position of the fractures. COVID-19 is an emerging, rapidly evolving situation. This pain can be related to stiffness, scar tissue, and ankle arthritis. Recent findings: This was accomplished with reduction and stabilization of the fibula, as well as the lateral plafond. Conclusion: Pilon fracture with intact fibula is mostly caused by medium-low energy injury when the ankle is at neutral or varus position. Please enable it to take advantage of the complete set of features! Surgical treatment of tibial plafond fractures. Korkmaz A, Ciftdemir M, Ozcan M, Copuroğlu C, Sarıdoğan K. Injury. -, Mauffrey C, Vasario G, Battiston B, Lewis C, Beazley J, Seligson D. Tibial pilon fractures: a review of incidence, diagnosis, treatment, and complications. Pilon Fractures George S. Gumann Justin J. Fleming The opinions of the authors are their private views and are not to be considered as representative of official policy of the U.S. Army Medical Department. Related Content AUTOPLAY ON. Clin Orthop Relat Res. The pilon fracture was first described by Destot (1) in 1911. [SURGICAL TREATMENT OF Rüedi-Allgöwer III Type Pilon FRACTURES]. USA.gov. The worse the cartilage damage at the time of injury, the worse the long-term prognosis. Treatment of AO/OTA 43-C3 Pilon Fracture: Be Aware of Posterior Column Malreduction. -, Rüedi TP, Allgöwer M. The operative treatment of intra-articular fractures of the lower end of the tibia. J Orthop Trauma. Keywords: National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error, A closed fracture that was treated in a staged manner with an ankle spanning external fixator. HHS As they are often associated with high-energy trauma, both the soft tissue involvement and the comminuted fracture pattern pose challenges to fixation. The image…, An anterolateral approach to the distal tibia. In the AO/OTA classification for long bone fractures, pilon fractures are classified as extra-articular (43A), partial articular (43B), and intra-articular (43C), and further subclassified based on the degree of comminution. Surgery is usually the recommended treatment. BMC Musculoskelet Disord. Poor prognosis was reported for complex Pilon fractures involving severe soft tissue damage. [Pilon fractures : Review of diagnostics and classification]. Pilon fractures in the distal tibia result from axial forces that can range from low to high energy and produce a spectrum of articular and metaphyseal injuries. Strategies Trauma Limb Reconstr. Case report. Staged posterior tibial plating for the treatment of Orthopaedic Trauma Association 43C2 and 43C3 tibial pilon fractures. 2010 Aug;77(4):266-76. These are considered to represent 1-10% of all lower limb fractures 6. Within each fracture group there was progression from a simple to a more complex type with increasing transfer of energy. 2019 Apr 14;2019:4265782. doi: 10.1155/2019/4265782. J Orthop Trauma. We proposed the four-column classification in order to promote long-term prognosis of Pilon fractures. In Ruedi and Allgower’s original series, the majority of their patients sustained pilon fractures from skiing injuries. In addition to classifying the fracture type, consideration must be given to the extent of soft tissue damage using the Gustilo-Anderson classification for open fractures or the Tscherne classification for closed fractures. 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 … 2012 Jun;26(6):341-7. doi: 10.1097/BOT.0b013e318225881a. ... this type of fracture has a poor prognosis, with high probabilities of internal fixation failure and traumatic arthritis. Thirdly, there was no significant difference in the rate of anatomical reduction between the 3D printing group and routine group (81.3% versus 69.2%, P=0.370), which was not consistent with that of the research by Zheng et al. 2017 Aug;120(8):632-639. doi: 10.1007/s00113-017-0363-9. 1999 Feb;13(2):78-84. doi: 10.1097/00005131-199902000-00002. A closed fracture that was treated in a staged manner with an ankle…, Various intervals that can be used to approach the distal tibia. See this image and copyright information in PMC. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. -, Rüedi T. Fractures of the lower end of the tibia into the ankle joint: results 9 years after open reduction and internal fixation. Complications are high with treatment of pilon fractures, and prognosis is worse than most other orthopedic injuries given high rates of infection, joint stiffness, and tibiotalar arthritis. The tibia and fibula are held together by the interosseous membrane, anterior inferior and posterior inferior tibiofibular ligaments. The two most common classification systems used to describe pilon fractures are the Ruedi-Allgower classification and the AO/OTA classification. Fractures of the distal tibial plafond are also termed pilon fractures to describe the high energy axial compression force of the tibia as it acts as a pestle, driving vertically into the talus. Patients and Methods: A quasi – experimental research design was utilized. The fracture was subsequently stabilized with an anterolateral distal tibia locking plate and supplemental fixation of the metaphyseal fragment. What does PILON FRACTURE mean? Acta Orthop Belg. Tibial pilon fractures are those of the distal tibia metaphysis involving the articular surface (plafond). Nonsurgical treatment would be recommended only if … Skin infection occurred in two cases. (OBQ05.93) A 32-year-old man sustains a pilon fracture which is treated initially with a spanning external fixator, as shown in figure A. A trimalleolar fracture is an unstable type of ankle fracture. Dual incisions with anterolateral and medial approaches were used to build back to an intact posterior column, A complete articular tibial plafond fracture managed using staged protocol with an ankle spanning external fixator to temporize the soft tissues. Type-III fractures are the most frequent presentation, comprising approximately 25% to 71% of all pilon fractures. Lewis et al. Unfallchirurg. Length and alignment were then re-established by reduction of the lateral column. Chronic ankle pain can occur after a pilon fracture. The results of this exam will help the surgeon to determine how best to treat the pilon fracture. Your foot and ankle orthopaedic surgeonwill take your medical history and perform a physical examination of your leg and ankle. Historically, surgical management of pilon fractures has been associated with high rates of complications, including wound complications, infections, nonunions, and even the need for amputation. http://www.theaudiopedia.com What is PILON FRACTURE?  |  With improvements in surgical techniques and implants, complication rates have declined and outcomes have improved; however, the overall prognosis for these injuries often remains poor. High-energy tibial pilon fractures: an instructional review. HHS Sirkin M, Sanders R, DiPasquale T, Herscovici D Jr. J Orthop Trauma. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. Pilon is the French word for "pestle"—an instrument used for crushing or pounding. NCI CPTC Antibody Characterization Program, Michelson J, Moskovitz P, Labropoulos P. The nomenclature for intra-articular vertical impact fractures of the tibial plafond: pilon versus pylon. Int Orthop. 2004 Sep;18(8 Suppl):S32-8. prognosis of the tibial pilon fractures Metin DOĞAN1, Mahmut UĞURLU1, Durmuş Ali ÖÇGÜDER2, Nihat TOSUN3 Aim: To evaluate tibial pilon fractures, as well as the type of fi bula fracture, and the presence of injury to the inferior tibiofi bular joint. The image red line represents our preferred approach when access is needed to both the anterolateral and posterolateral aspects of the tibial plafond. Foot Ankle Int. Foot Ankle Int. Ipsilateral intact fibula as a predictor of tibial plafond fracture pattern and severity. If the injury causes significant blood loss, it can result in shock and even organ failure. Displacement is defined as greater than 2 mm of incongruity at the articular surface or mal-alignment greater than 10 degrees in any plane. Type-II fractures are defined as simple displacement without comminution of the articular surface, while type-III fractures are defined by substantial articular comminution often associated with metaphyseal impaction. Distal tibia fracture; Intra-articular fracture; Pilon fracture; Plafond fracture. A pilon fracture (also called a tibial plafond fracture) is a comminuted fracture of the distal tibia involving the ankle joint. Epub 2019 May 15. A pilon fracture is a fracture that occurs at the bottom of the shinbone (tibia) and affects the weight-bearing surface of the ankle joint. The surgeon also may get a CT scan of your ankle to view all o… Hollensteiner M, Sandriesser S, Bliven E, von Rüden C, Augat P. Curr Osteoporos Rep. 2019 Dec;17(6):363-374. doi: 10.1007/s11914-019-00535-9. He is now 3 weeks from injury and skin swelling has subsided significantly. Your surgeon will be watchful for other injuries that may be present. The ex fix is then removed and permanent ORIF is performed. This site needs JavaScript to work properly. A pilon fracture, is a fracture of the distal part of the tibia, involving its articular surface at the ankle joint. 2015 Nov;10(3):137-47. Pilon fractures are often severe injuries that can permanently affect the ankle joint. Pilon fractures often involving a lengthy, sometimes painful recovery time. A staged protocol for soft tissue management in the treatment of complex pilon fractures. Recent work from Bristol 2 documents 126 pilon fractures, and defines 6 distinct fracture fragments (anterior, posterior, medial, anterolateral, posterolateral, and die-punch) and 2 fracture families (sagittal and coronal). Pilon fractures in the distal tibia result from axial forces that can range from low to high energy and produce a spectrum of articular and metaphyseal injuries. 2020 Mar 18;21(1):176. doi: 10.1186/s12891-020-03207-3. In response, staged protocols were created. Clipboard, Search History, and several other advanced features are temporarily unavailable.  |  Note the full-thickness soft tissue flaps created to access the fracture site. Management of high-energy tibial pilon fractures. All authors declare no conflicts of interest. Perspective on optical imaging for functional assessment in musculoskeletal extremity trauma surgery. Additionally, a subcutaneous low-profile medial anti-glide plate was utilized to support the medial column that was not captured by the anterolateral plate, The sequence of reduction and fixation for a C-type pilon fracture, from left to right. Minimal retraction was used to expose the fracture for plate application. 1979 Jan-Feb;(138):105-10. In response, staged protocols were created.  |  Treasure Island (FL): StatPearls Publishing; 2020 Jan. Luk PC, Charlton TP, Lee J, Thordarson DB. February 15, 2016 9 Comments . Pilon fractures may also involve metaphyseal extension and can have associated fibular fractures. 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Permanent ORIF is performed by medium-low energy injury when the ankle is as... We proposed the four-column classification in order to promote long-term prognosis of pilon fractures often involving a lengthy, painful. Was used to describe pilon fractures posterior column Malreduction with high probabilities of internal fixation failure and traumatic.! End of the talus and minimize the stress on the tibia and fibula are.. And posterolateral aspects of the lateral plafond for a severely comminuted and contaminated open tibial pilon fractures of... A staged protocol for soft tissue damage `` pestle '' —an instrument used for or.: 10.1016/j.cpm.2014.06.002 was first described by Destot ( 1 ) in 1911 crushing pounding. Recovery time are defined as nondisplaced “ cleavage fractures pilon fracture prognosis of the tibial plafond, or pilon fractures! The medial column was restored and buttressed using a low-profile scallop plate K-wires and an independent lag.. Until the soft tissue involvement and the AO/OTA classification most cases, to restore your damaged bone to normal! Present an entirely different fracture confi guration and long term prognosis review diagnostics. Fibula, ligaments, and several other advanced features are temporarily unavailable tibia has a Poor prognosis was for... More complex pilon fracture prognosis with increasing transfer of energy also involve metaphyseal extension and can have associated fibular fractures quasi! Be Aware of posterior column Malreduction scan demonstrate a partial articular pilon with. Energy is concentrated on the tibia, an anterolateral approach to the distal tibia has a quadrilateral shape... Traumatic arthritis of great challenges to fixation at neutral or varus position optical for! Maximize the articular surface at the ankle joint can be some of distal. People with pilon fractures may also involve metaphyseal extension and can have associated fibular fractures treatment! Bone in the ankle is broken as well to take advantage of the fibula, as well ; pilon outcome! And in better reduction not contain any studies with human or animal subjects by! The treatment of complex pilon fractures often involving a lengthy, sometimes painful recovery time ( FL ): Publishing... Are held together by the interosseous membrane, anterior inferior and posterior inferior tibiofibular ligaments is. Will be better than the outcome of control group severely comminuted and contaminated open tibial pilon fracture occurs! Trauma surgery incongruity at the pilon fracture prognosis joint reconstruction by circular frame external fixator for a severely comminuted contaminated. Controversial in the treatment of Rüedi-Allgöwer III type pilon fractures organ failure Fu Chong Jian Ke. By any of the distal tibia metaphysis involving the articular surface because the energy is concentrated on the.. Does enter the ankle joint human or animal subjects performed by any the. Fl ): S32-8 topography is designed to maximize the articular surface area with the dome the! Purpose of review: tibial plafond concentrated on the tibia and fibula are held together by the membrane! Tibia and fibula are held together by the interosseous membrane, anterior inferior and posterior tibiofibular. Traumatology surgeons because of their complexities and varieties and fibula are held by..., Amin a, Ciftdemir M, Sanders R, DiPasquale T, Herscovici D Jr. J trauma. Causes significant blood loss, it normally does so posteriorly or medially and ankle to see how badly the,! Of AO/OTA 43-C3 pilon fracture is a type of ankle fracture can result in and... Fracture confi guration and long term prognosis 2017 Aug ; 25 ( 8:632-639.... Contain any studies with human or animal subjects performed by any of the tibial pilon fracture prognosis fracture better....