Pilon Fractures

Management and Treatment

How is a pilon fracture treated?

Treatment for a pilon fracture depends on several factors, including:

• The number of fractures.
• The pattern and type of the fracture.
• If the bones are displaced (not aligned) and how much they’re displaced.
• If surrounding soft tissues, such as muscle, tendons and skin, are damaged.
• Your overall health and if you have other injuries.

If you have a pilon fracture that isn’t displaced and your bones are still aligned properly, you may not need surgery. Non-surgical treatment for pilon fractures can include:

• Rest: Your healthcare provider will most likely recommend that you rest as much as possible with your affected leg elevated so that you don’t put extra pressure on your pilon fracture.
• Casts, splints and/or boots: Your healthcare team will likely have you wear a splint, cast and/or boot as your fracture heals to stabilize your ankle.
• Walking aids: Your healthcare team may have you use a walking aid such as crutches to avoid bearing weight on your affected leg. You may have to use the walking aid for up to three months or until your pilon fracture is fully healed.
• Medications: Your healthcare provider may have you take a blood thinner medication (anticoagulant) to reduce your risk of having blood clots form in the veins of your legs.
• Physical therapy: You may have to go through physical therapy to restore strength in your leg and ankle after your fracture(s) has healed.

If you have a pilon fracture that is displaced and the bones aren’t aligned properly, you’ll likely need surgery. Depending on the severity of your fracture and if you have other injuries, your healthcare team may delay your surgery until the swelling around your ankle has settled and you are healthy enough to undergo surgery to minimize risks such as infection. Types of surgeries used to treat pilon fractures include:

• Open reduction and internal fixation: During open reduction and internal fixation surgery, the displaced bone fragments are first repositioned into their normal alignment. The fragments are then held together with screws or metal plates that are attached to the outer surface of the bone. Your surgeon can only do this kind of surgery to fix your break if your surrounding skin and tissues are healthy.
• External fixation: In this surgery, your surgeon makes small incisions (cuts) into your skin and inserts metal pins through your bones. The pins stick out of your skin and are attached to bars outside of your body. The external fixator acts as a frame to help hold your ankle in a stable and secure position until your surgeon can perform a second surgery (usually open reduction and internal fixation) to fix your fracture.

Post-surgery treatment for pilon fractures can include:

• Medication: Your healthcare provider may have you take blood thinner medication (anticoagulants) to help prevent blood clots from forming in your legs.
• Rest: You will have to rest a lot after your surgery so that your bones and incisions can heal. Your ankle will likely be immobilized in a cast for six weeks or more after surgery. Be sure to follow your healthcare team’s instructions for rest and movement.
• Physical therapy: Once you’re allowed to start using your ankle, your provider may put it in a removable cast boot or brace so that you can begin physical therapy. Specific exercises will help improve the strength and range of motion in your ankle.

People who experience a pilon fracture from a high-impact event such as a car accident often have other injuries that will also need to be treated. In these cases, the success in treating the pilon fracture often depends on the success of treating the related injuries.

How long does it take a pilon fracture to fully heal?

The length of time it takes for a pilon fracture to heal depends on the severity of the injury and if the individual had other injuries from the event that caused the pilon fracture. Most pilon fractures require surgery. It usually takes three to six months after surgery for the fracture to heal completely. However, it often takes individuals a year or more to fully recover from the injury.