30/07/2021
*Pilon Fractures*
Pilon fractures include a wide range of complexity. The timing and type of definitive fixation is dictated by the soft tissue injury and energy imparted to the fracture. One should have a low threshold for staged protocols and delayed definitive fixation to avoid complications. Proper radiographs and advanced imaging should be obtained for an exacting diagnosis and preoperative planning. Diligent management of the soft tissue and anatomic restoration of the articular surface, length, rotation, and axial alignment with stable fixation to the diaphysis should be obtained once feasible. Intramedullary implants with percutaneous articular fixation for simple or extra-articular patterns provide good results with little soft tissue insult in the zone of injury. Minimally invasive plate osteosynthesis techniques can help mitigate some concerns with soft tissue compromise while obtaining good articular alignment. Locking or conventional plating with lag screw fixation is used for complex articular injuries with or without fibular fixation.
Types of pilon fracture
Articular fracture with minimal or no displacement.
Displacement of the articular surface but with minimal or no comminution.
Marked comminution as well as articular impaction.
The number of fractures
The amount and size of the broken bone fragments
The amount each piece is out of place (displaced). In some cases, the broken ends of bones line up almost
correctly; in more severe fractures, there may be a large gap between the broken pieces, or the fragments
may overlap each other.
The injury to the surrounding soft tissues, such as muscle, tendons, and skin
Symptoms
Swelling Bruising Tenderness Deformity Inability to bear weight on the injured leg
Nonsurgical Treatment
Splints and casts: In most cases, your doctor will first apply a splint to hold your ankle in place. Once the swelling goes down, he or she will replace the splint with a short leg cast. To provide effective support, your cast must correctly fit your ankle. For this reason, as the swelling in your ankle decreases, you may need frequent cast changes.
Monitoring: Your doctor will closely monitor the healing of your fracture. During this time, you will need to return regularly for follow-up x-rays to make sure your ankle remains stable.
Recovery: You will most likely be unable to bear weight on your ankle for up to 12 weeks after your injury. During this time, your doctor may recommend that you use crutches or a walker. After 6 weeks, your doctor may replace your cast with a removable brace. This will offer protection while your ankle continues to heal.
Surgical treatment
pen Reduction and Internal Fixation: During this operation, the displaced bone fragments are first repositioned (reduced) into their normal alignment, and then held together with screws and metal plates attached to the outer surface of the bone.
Timing of Surgery: If you have significant swelling or blisters, your doctor will delay your surgery until the swelling goes down. Performing surgery too soon increases your risk for infection or problems with your incision. Your surgery may be delayed for up to 2 weeks or more, depending on how long it takes for the swelling to go down.
Complications After Pilon Fractures Infection
Infection Sniffness Posttraumatic Arthritis Bone Healing Problems
