Distal tibia (pilon) fractures

A 42-year-old male slipped and fell approximately 14 feet while working on a ladder onto his right lower extremity.

He was taken to our Emergency Department and radiographs revealed a right-sided displaced distal tibial pilon fracture with extensive articular comminution and associated displaced fibula fracture with significant soft tissue swelling.

A spanning external fixator was placed for initial treatment followed by Open Reduction and Internal Fixation (ORIF) of his fibula fracture with placement of a 7-hole locking plate to achieve restoration of length. ORIF of the pilon fracture was performed at 3 weeks following resolution of the soft tissue swelling and the fracture was reduced and fixed.  Two locking plates and screws were placed laterally and anteriorly.

He returned for follow-up visits at regular intervals and at 5 months following the index surgery radiographs revealed a healed distal tibial pilon fracture in good alignment and he reported resolution of pain and return to pre-injury activities.

  • Figure A

    Figure A

    Anteroposterior (AP) and lateral radiographs illustrating a right-sided displaced distal tibial pilon fracture with extensive articular comminution and associated displaced fibula fracture and (right images) fluoroscopic and AP x-ray following placement of external fixation and ORIF of the fibula fracture.

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  • Figure B

    Figure B

    CT scan images further delineating the fracture pattern and pre-operative surgical plan.

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  • Figure C

    Figure C

    Radiographs at 5 months following the index surgery reveal a healed pilon fracture in excellent alignment and maintenance of fixation.

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David L. Helfet, MD

535 East 70th Street
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