Pilon Fracture

A pilon fracture is a high-energy axial compression fracture of the distal tibia that shatters the tibial plafond (articular surface). It occurs from falls from height or ski injuries, and is associated with significant soft-tissue injury. Pilon fractures represent one of the most challenging fractures to treat in orthopedic surgery — articular comminution, bone loss, and soft-tissue compromise must all be addressed. Staged management (temporary external fixation until soft-tissue swelling resolves, then definitive ORIF) is standard.

AP, lateral, and mortise ankle X-rays. CT with 3D reconstructions is mandatory for surgical planning, defining articular fragments, degree of comminution, and impaction. Soft-tissue assessment (fracture blisters, skin viability) is critical before surgical timing is determined.

Virtually all displaced pilon fractures require staged surgical reconstruction once the soft-tissue envelope permits.

External patient-education references and related OSI pages for additional background:

• Britannica — Bone disease (fractures)
• Britannica — Ankle (anatomy)
• AAOS OrthoInfo — patient education library
• OSI glossary — orthopedic terminology in plain language