What are Tibial Plafond Fractures/Pilon Fractures?
A fracture is defined as a break in the continuity of the bone when a force against your body is too strong for the bone to bear. A tibial plafond fracture, also referred to as pilon fracture, is a type of break of the tibia (shinbone) that occurs close to the ankle joint. In most cases, a pilon fracture results in the breaking of both the tibia and fibula of the lower leg. The lower edge of these bones forms a portion of the ankle. The tibia and fibula are long shin bones, which articulate with the thigh bone on one end and the ankle joint at the lower end. The part of the tibia that articulates with the talus (ankle bone)is called the tibial plafond or pilon.
Causes of Tibial Plafond Fractures/Pilon Fractures
Fractures of the tibial plafond are relatively rare, occurring as a result of a high-intensity trauma such as a fall from a height or a motor vehicle accident that forces the ankle up against the tibia, often causing the bone to shatter as in a comminuted fracture - a severe type of fracture where the bone breaks into 3 or more pieces. The fracture is often accompanied by damage to soft tissue, articular cartilage, and underlying bone, which can lead to post-traumatic arthritis.
Signs and Symptoms of Tibial Plafond Fractures/Pilon Fractures
Tibial plafond or pilon fractures are usually accompanied by:
- Severe pain
- Tender to touch
- Inability to bear weight
- Bone deformity
When you present to the clinic with a pilon fracture, your doctor performs a physical examination of your lower legs and ankle to inspect the degree of swelling, tenderness, disruption of skin, and to assess nerves and blood supply is intact. Additionally, in order to obtain further information on the condition of the soft tissue around the fracture and severity of the fracture in more detail, your doctor may recommend:
- X-rays: This study uses high electromagnetic energy beams to produce images of the bones and helps to detect whether the bone is intact or broken and the type of fracture and its location.
- CT scan: This scan uses special x-rays that produce images of the cross-section of your lower leg with clear images of any damage present that is not visible in an x-ray. It provides your doctor with crucial information about the severity of the fracture.
Treatment for tibial plafond fractures depends upon the severity of the fracture and involves both non-surgical and surgical methods.
Conservative methods are the choice of treatment for stable fractures where bone fragments are not displaced or minimally displaced. Emergency treatment includes irrigation of the open wound and administration of antibiotics to control infection. Pain and swelling is controlled with medication, ice application, the elevation of your foot, or application of temporary splints and short-leg casts to hold the ankle in place, followed by monitoring of the fracture healing with a series of follow-up X-rays to ascertain the ankle remains stable. Splints or casts are normally recommended if the fracture is not displaced or your health does not permit surgery.
Surgery is usually advised for unstable fractures where the bones are out of place. These include:
- Open Reduction and Internal Fixation (ORIF): ORIF refers to making an open incision (long surgical cut) to access the broken bones and reposition or realign them into their normal position. Internal fixation refers to utilizing fixation devices such as metal plates, screws, or rods to stabilize and hold the broken bones in place together while they heal.
- External Fixation: During this procedure, screws or metal pins are placed into the bone below and above the site of the fracture. The screws and pins are secured to a bar or circular frame outside the skin which holds the bones in the correct position while they heal.
- Intramedullary Nailing: During this procedure, a metal rod is placed into the central canal of the tibia passing across the fracture site. Both ends of the intramedullary nail are screwed to the bone to keep the bones and nail in proper position while the fracture heals.
- Ankle Arthrodesis: Ankle arthrodesis is the surgical fusion of bones that form the ankle joint. It can be performed as an arthroscopic or open surgery. The approach for an open technique can be either from the anterior (front) aspect or lateral (side) aspect of the ankle. The joints are then fused together with the help of screws, wires, plates, or rods. Bone grafting is recommended in cases of substantial bone loss. This is done using a graft taken from another part of your body (autograft) or donor tissue (allograft).