What are the other Names for this Condition? (Also known as/Synonyms)

• Hammer Fracture
• Pilon Fracture of the Ankle

What is Pilon Fracture? (Definition/Background Information)

• Pilon Fractures are injuries that occur, when the tibia (shinbone) cracks/breaks/fractures near the ankle joint, into one or more pieces, mainly due to effect of axial forces (normally high-energy) on the tibia, which may crush the ankle bones
• A high percentage of such fractures, involves both the fibula and tibia (the two bones of the lower leg)
• These fractures are usually caused by a high-energy impact that results from an athletic sport, motor vehicle accident, or a fall from a substantial height
• On average, this injury predominantly seems to occur in male individuals, between the ages of 35-40 years

Who gets Pilon Fracture? (Age and Sex Distribution)

• Pilon Fractures are non-specific fractures, and as such, may occur in individuals of any age, race, ethnic group, and gender
• Young athletes (who participate in high-impact sports), men in the 35-40 year age group, all have a high rate of occurrence
• Men are 3-times more likely to experience this injury, than women

What are the Risk Factors for Pilon Fracture? (Predisposing Factors)

Common risk factors associated with a Pilon Fracture include:

• Participation in high-risk contact sports, such as football, basketball
• Middle-aged men between the ages 35 and 40 years, are a high-risk group

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Pilon Fracture? (Etiology)

Some causes of a Pilon Fracture include:

• Falling from a significant height; especially landing on one’s legs/heels (or the fracture occurring since the individual is overweight)
• Automobile, motorcycle, or bicycle accidents
• Taking part in any rough or high-impact sport

It has been observed that airbags do a phenomenal job of saving lives, of those who are involved in high-speed car accidents. However, a high percentage of such individuals, seem to experience Pilon Fractures, due to the inability of airbags to protect one’s legs.

What are the Signs and Symptoms of Pilon Fracture?

Signs and symptoms of a Pilon Fracture include:

• Severe and immediate pain at the site, where the injury occurred
• Swelling; tender sensation to touch
• Noticeable bruising, abnormal deformity of the ankle
• Inability to apply weight, or bear any pressure on the foot

How is Pilon Fracture Diagnosed?

Diagnostic methods that a physician may use to help diagnose a Pilon Fracture include:

• Physical examination: A thorough physical examination is important in identifying any noticeable deformities, swelling, contusions, in the ankle/foot. Individuals are also expected to provide an explanation of the circumstances that caused the injury. In addition to this, a complete medical history can aid in arriving at a definitive diagnosis
• X-ray: X-rays are the most common methods to evaluate a fracture, especially if the bone has been displaced. This diagnostic test will provide a clear image of the bone, identify the exact location of the injury, and determine the extent of the fracture
• Computerized tomography (CT) scan: A CT scan takes a series of x-ray images from several different angles. These images are then merged to create cross-sectional images of bones and soft tissues of the body, which then allows a physician to examine the ankle/foot and surrounding structures

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Pilon Fracture?

Complications associated with a Pilon Fracture include:

• Additional fracture injuries to other bones of the ankle and foot
• Degenerative joint disease (osteoarthritis)
• Osteonecrosis: A serious disorder characterized by a temporary or permanent disruption of blood flow to the bones
• Prolonged and chronic pain
• Infection of the bone (osteomyelitis)
• Permanent disability of the leg/ankle

How is Pilon Fracture Treated?

A high percentage of Pilon Fractures require surgery. However, this injury may also be treated non-surgically. The non-surgical treatment methods include:

• Any activity that aggravates the ankle/foot/leg condition should be avoided. The physician may advise the individual to refrain from participating in any physical activities, till the pain or symptoms get better
• Applying ice to the ankle can help reduce pain and swelling
• Complete immobilization of the ankle/foot with a cast, may be required to restrict movement
• Non-steroidal anti-inflammatory oral medications, such as indomethacin and naproxen, may be used to treat a Pilon Fracture. These medications can help decrease the pain and swelling

Surgical treatment methods include:

• Open reduction and internal fixation (ORIF): Open reduction is a surgical procedure to realign the fractured bone, to its original position. Surgical hardware (such as plates, screws, or rods) is then used to stabilize the fractured bone under the skin

How can Pilon Fracture be Prevented?

To prevent a Pilon Fracture, individuals should be careful and consciously aware, while performing any physical activities, such as sports, or even some normal daily activities that could lead to situations involving accidents. Children must be provided a safe environment to work, study, or play. Any possible dangers should also be anticipated and appropriate safety measures adopted.

A few ways to further help prevent unwanted injuries or Pilon Fractures include:

• Individuals who participate in any high-risk sports, should wear appropriate safety equipment to help prevent the possibility of such fractures
• Wearing appropriate footwear (such as the proper shoe size), may help prevent accidents
• Consuming foods rich in calcium, such as milk, yogurt, and cheese, help build bone strength. Regular diet with appropriate calcium-intake is recommended, even after a Pilon Fracture. For women, the recommended amount of calcium, increases with age and menopause
• Perform weight-bearing exercises to strengthen bones

What is the Prognosis of Pilon Fracture? (Outcomes/Resolutions)

• A high percentage of Pilon Fractures heal without any serious complications
• A full recovery and a return to sports or normal daily activities usually require a few weeks to months, depending on the severity of the injury
• When properly treated and rehabilitated, usually under the guidance of a physiotherapist/specialist, a high percentage of individuals regain their full strength and range of motion in the injured leg

Additional and Relevant Useful Information for Pilon Fracture:

Pilon is a French word for pestle, which is a club-shaped object used to crush or grind various ingredients in a mortar (bowl). A Pilon Fracture refers to crushing of the ankle, due to sudden axial forces applied on the lower leg bones.