Our daughter was in a horseback riding accident that resulted in many fractures in her ankle. The surgeon called it a pilon fracture and showed us drawings and computer calculations for how the surgery will be done. Do these type of fractures always take this much coordination, thought, and planning? We're pretty impressed with the surgeon but maybe this is standard operating procedure so-to-speak.
The term pilon fracture (also known as a hammer) fracture occurs when one bone is driven into another bone with force. The bone may be broken into more than one piece. This is a comminuted pilon fracture.
The most common pilon fracture affects the lower end of the tibia. The break occurs across the entire bone and into the ankle joint. It results from a high-energy, loading injury from the foot up into the bone. Car accidents, skiing injuries, and falls during horseback riding are the most commonly reported cause of pilon fracture.
Pilon fractures are indeed difficult to manage. There is often damage to the joint surface, soft tissue complications, and poor outcomes. It often requires one or more operations to repair the damage. In 10 percent of cases, fusion of the joint is needed.
Advances in surgical management are ongoing and it sounds like your surgeon is keeping abreast of the changing times. As you have seen, surgical management for pilon fractures begins with careful preoperative planning. Preoperative planning often requires assessing patient risks for success or failure of surgical management.
The surgeon also examines the fracture from every angle trying to see where all the damage has occurred and preparing a plan of action. It may be helpful to trace the X-rays and create an overlay that can be used to plan out the surgical approach. Computer computations can be used to calculate the best way to align the bones and joints while taking into consideration the condition of the surrounding soft tissues.
Surgical fixation will be needed. This requires the use of pins, screws, wires, cages, and/or plates to hold the bones together until healing takes place. Strategic placement of fixation devices may improve the results. Bone graft may be used to prevent bone collapse and help stimulate bone growth. Planning ahead how to best use these resources (as your surgeon has done) is really the best way to assure a good result with this type of injury. Sounds like your daughter is in good hands.
Brett D. Crist, MD et al. Pilon Fractures: Advances in Surgical Management. In Journal of the American Academy of Orthopaedic Surgeons. October 2011. Vol. 19. No. 10. Pp. 612-622.
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