Pilon fractures are rare but severe bone breaks that happen at the bottom of your shinbone near your ankle. They’re typically caused by high-impact events such as vehicle accidents. Treatment usually involves surgery.
A pilon fracture is a relatively rare bone break that happens at the bottom of your tibia (the larger of the two bones in your lower leg, or your shinbone) near your ankle. In many cases of pilon fractures, the other bone in your lower leg, your fibula, is broken as well. Most cases of pilon fractures are caused by high-impact events, such as a vehicle accident or falling from a significant height.
“Pilon” is the French word for pestle, which is a tool with a rounded end that’s used to crush and grind substances. This type of bone break is called a pilon fracture because of the crushing force that often causes them. Your tibia and fibula are attached to your talus, which is the weight-bearing bone in your ankle. Pilon fractures happen when your talus is driven into your tibia with such force that your tibia (and often your fibula as well) breaks at your ankle joint.
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There are several types of pilon fractures depending on the pattern of the break, and there are many classification systems to describe them. Under the Ruedi-Allgower classification system, healthcare providers categorize pilon fractures as the following types:
There are also types of fractures that can apply to any bone break. Your healthcare provider may use one or more of the following terms to describe your pilon fracture:
Pilon fractures can be challenging to treat because they involve the ankle joint and there’s usually damage to surrounding soft tissues such as muscle, skin and ligaments. Approximately 20% of pilon fractures are open fractures, which means the broken bone has pierced through the skin. Open fractures can lead to infection, which can be dangerous. Pilon fractures are often severe injuries that can cause long-term issues, such as arthritis in your ankle joint.
Anyone can experience a pilon fracture at any age. Males between the ages of 25 and 50 are more likely to get a pilon fracture from a high-impact event such as a vehicle accident. Older females who have osteoporosis are more likely to get a pilon fracture from a low-impact event such as a minor fall.
Pilon fractures are relatively rare. Approximately 1% to 10% of lower leg or tibia fractures are pilon fractures.
Signs and symptoms of a pilon fracture can include:
Most pilon fractures happen when your talus (the weight-bearing bone in your ankle) is driven into your lower leg bone(s) (your tibia and fibula) with such force that your leg bone(s) breaks at your ankle joint. There are a few situations or conditions that can cause pilon fractures, including:
Pilon fractures require X-rays in order to be diagnosed. Your healthcare team may have you undergo other imaging tests to learn more about your injury.
The following imaging tests can be used to diagnose a pilon fracture:
Treatment for a pilon fracture depends on several factors, including:
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:
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:
Post-surgery treatment for pilon fractures can include:
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.
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.
Some risk factors for getting a pilon fracture include:
Depending on your age and lifestyle, there are a few things you can do to try to prevent getting a pilon fracture, including:
Despite advances in imaging technology and surgical approaches, pilon fractures are challenging to treat. This is because pilon fractures often cause damage to the ankle joint itself and the surrounding soft tissues such as muscle and ligaments. It can take individuals a year or more to fully recover from the injury, and long-term ankle arthritis is common following a pilon fracture.
Your risk of complications from your pilon fracture depends on how severe the fracture is and if you had other injuries from the event that caused your pilon fracture. Complications caused by a pilon fracture can include:
If you are experiencing signs and symptoms of a pilon fracture such as intense pain in your lower leg and ankle and having a crooked or deformed ankle, see a healthcare provider right away. If you can’t get to urgent care or an emergency room on your own, call 911 for help.
If you had surgery to fix your pilon fracture and are experiencing signs of infection, such as having redness, pus or warmth at your surgical wound or having a fever, go to the nearest hospital as soon as possible.
A note from Cleveland Clinic
While pilon fractures are rare, they can be serious injuries. Know that your healthcare team will help you along the way to your recovery. Don’t be afraid to ask questions about your injury and treatment plan. They are there to help you.
Last reviewed by a Cleveland Clinic medical professional on 09/23/2021.
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