A grade III injury is a closed fracture with extensive contusion or crushing of the skin and muscle. There is a moderately severe to severe fracture configuration. A grade II injury is a closed fracture with deep abrasion with local skin and muscle contusion. There is mild to moderately severe fracture configuration. The pressure against the skin occurs as it is stretched over the fracture margins. A grade I injury is a closed fracture that has a contusion or superficial abrasion. There is an indirect mechanism of injury producing a simple fracture configuration. A grade 0 injury involves a closed fracture with minimal soft tissue damage. Tscherne and Gotzen ( 10) have developed a grading system for soft tissue damage. Today, it is recognized that soft tissue management is equally important as osseous treatment. The factors that need to be considered include patient’s age, comorbid medical issues, activity level, employment, postinjury expectations, ability to tolerate potential complications, the experience of the surgeon, the degree of osseous involvement, and the soft tissue damage. The injured extremity should be protected with a splint or if surgery is to be delayed, a padded dressing applied along with a splint or in a bivalved cast. Any significant deformity should be reduced in the emergency room under conscious sedation unless expedient transportation to the operating room is possible. Clinical examination and radiographic studies readily demonstrate a pilon fracture. After completing the history, physical examination, radiographs, any appropriate laboratory studies, necessary consultations, and resuscitation measures for the patient, the next step is to stabilize the fracture. There are varying degrees of soft tissue damage, deformity, osseous comminution, intra-articular involvement, and metaphyseal loss of bone. Pilon fractures are complex injuries involving the soft tissue envelop along with the osseous structures of the distal leg and ankle. Common mechanisms of injury include motor vehicle accidents, falls from heights, and skiing accidents. One-third are associated with other injuries. Approximately 20% to 25% of these injuries are open. Pilon fractures represent less than 1% of all lower extremity fractures and 1% to 10% of all tibial fractures ( 2, 3). The subsequent soft tissue injury is generally less morbid and typically allows for a more favorable prognosis. This results in less complex articular injury. Rotational forces produce a low-velocity-type injury with a spiral configuration of the distal tibia, which may or may not enter the ankle joint. There is usually, but not always, an associated fibular fracture. Due to these factors, the overall prognosis is very problematic. Compressive-type fractures are high-velocity injuries in which the talus impacts the distal portion of the tibia, producing bony comminution, varying degrees of displacement, major articular derangement, and significant soft tissue damage. Some fractures may exhibit elements of both mechanisms. These injuries are generally produced by either axially/compressive loading patterns or rotational forces. A pilon fracture involves the distal tibial metaphysis with extension into the ankle joint. Severe fractures require surgery to realign and stabilize the bones.The pilon fracture was first described by Destot ( 1) in 1911. Some pilon fractures may be treated with a splint or cast, rest, and anti-inflammatory medication. Treatment options depend on the severity of the injury. TreatmentĪ pilon fracture is a medical emergency that requires urgent treatment. In cases where pilon fractures result from a fall from a height, spinal compression fractures are also commonly present. Other symptoms may include deformity of the ankle, swelling, bruising and tenderness. Symptoms of pilon fracture include severe pain and an inability to bear weight on the leg. Other common causes of pilon fractures include automobile crashes, motorcycle crashes and skiing accidents. Such an injury commonly causes pilon fractures of both legs. This type of high-energy impact often occurs when a person falls from a height and tries to land on his feet. Pilon fractures are caused by a severe impact trauma to the feet and legs that forces the talus bone of the ankle upward, where it strikes the base of the tibia with excessive force. In many cases, when the tibia is fractured, the thinner bone in the lower leg (called the fibula) is also broken. Pilon fractures involve the weight-bearing surface of the tibia, and typically occur just above the ankle. This injury is a fracture at the base of the tibia (the largest of the two bones in the lower leg).
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