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“Pilon” is the French word for “pestle”, and is probably the “fittest” name to describe fractures in the lower end of the tibia, as it actually describes the injury mechanism: The ankle strikes and enters the loaded area of the distal tibia, and thus a fracture of the distal metaphysis of the tibia extends to the articular surface of the ankle. Just like the pestle crushes what’s inside the mortar.
In the international literature, these fractures are also called plafond fractures, and we are talking about a high energy axial compression injury, a common finding in traffic accidents (especially when the airbags open), falls from a great height and accidents during skiing. As a rule, they are severe, and often accompanied by a fibula fracture. At the same time, the lesions observed in the soft tissues surrounding the distal tibia may be serious, as sharp bone fragments may injure the adjacent muscles, nerves or blood vessels. Moreover, severe traumatic oedema can lead to the so-called compartment syndrome, a particularly painful condition that occurs when pressure within the muscles and around the nerves builds to dangerous levels.

Those who have suffered a Pilon fracture report that they immediately felt searing pain. Other symptoms, apart from traumatic oedema, are bruising, sensitivity upon palpation, foot weakness to lift the body weight, and the change in the joint shape, as the ankle may look crooked or dislocated.

Surgery is required in most cases, in order for the bones to be reset, and for the concomitant lesions to be treated - patients who can not walk very well, or who have other significant health problems, are considered unsuitable for surgery. In any case, the orthopaedist shall assess the severity of the injury based on the number of fractures, the number and size of the bone fragments, the degree of bone dislocation, and of course, the lesions in the soft tissues, vessels and nerves.
Surgery may need to be delayed for one to two weeks after the injury, or for as long as it takes, in order for the swelling to subside. During this period, the extremity is immobilized and the patient remains abed. Open (or complex) fractures, which are treated immediately, are an exception. Depending on the extent of the damage, and always at the discretion of the surgeon, surgical stabilization can be effected using an intramedullary rod, or through an internal or external fixation. If necessary, one or more external screws (tibiofibular syndesmosis) are placed transversally, in order to hold the tibia and fibula bones together; they are removed after about six weeks, during a second minor surgery.
The most frequent complications of tibia fractures are poor alignment or weakness of the correct placement of the fractured fragments, infection, nerve or vascular damage, blood clots, pseudarthrosis (failure of bone healing), and “angulation” ( in case of an external fixation).
Postoperatively, and for a period of 6 to 12 weeks, as appropriate, the patient should not fully burden their foot. To prevent pes equinus, a splint (of plaster or polymer) which holds the ankle at a 90-degree angle, is placed. During the first few days after surgery, the extremity remains at an elevated position, in order for the post-operative swelling and the throbbing pain sensation to subside, while the patient is encouraged to move their toes from day one. When the splint is removed, the mobilisation of all the joints begins, in order for the normal motion range to be restored. Usually, the gradual strengthening of the foot muscles begins at six weeks after surgery, where the external screws are removed (if any).

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