Pilon Fracture ORIF
Patients who have suffered a displaced Pilon (Plafond) fracture often benefit from surgery to reposition the bones that make up the top part of the ankle joint. The goal of surgery is ideally to put the bones back into the position that they were in prior to the injury. This can be a very challenging operation because the fracture involves the weight-bearing portion of the ankle joint itself, and the bones are often broken into a number of pieces. Patients that are healthy and do not have any contraindication for surgery are likely to benefit from this procedure if they have suffered a significantly displaced Pilon fracture.
Initial treatment often involves letting the soft tissue that surrounds the ankle settle. Operating through swollen, angry, soft tissue may increase the chance of having a wound complication. However, if the soft tissues are acceptable or if the swelling has settled, the procedure is performed by exposing the fracture site. It is often necessary to use two or more incisions in order to adequately reposition the fracture fragments and stabilize them with plates and screws. The actual location of the incisions may vary depending on the fracture site, but often includes an incision at the front and inside part (anteromedial) of the ankle, as well as the front outside part (anterolateral) of the ankle. The surgeon will rebuild the broken ankle joint one piece at a time, stabilizing them initially provisionally with wires, and then eventually definitively with screws and a plate(s). In some instances, it may be necessary to bone graft the fracture if there is a significant defect that is left after the fracture has been reduced.
The recovery from this type of injury and the associated surgery is long. It is often 12 weeks before there is enough bone healing to begin any sort of weight bearing. Until the bone is adequately healed, the patient will need to be relatively immobilized, often in a cast. During this time, movement of the knee and toes can be instituted. Once the fracture has healed, rehabilitation is oriented toward regaining motion in the ankle joint; rebuilding the muscles of the lower leg; and working on balance and gait retraining. This can take many months of formal and informal physical therapy. It is not uncommon for it to take 18 months or more to reach the point of maximum improvement following this type of injury.
- Post-traumatic ankle arthritis: Invariably there will be some arthritis of the ankle joint, and with bad Pilon fracture this arthritis can be extensive, leading to pain and swelling in the ankle joint. Successful surgery to reduce the fracture will help minimize the extent of arthritis, but it cannot eliminate the formation of arthritis when there has been significant damage to the joint.
- Wound healing issues: Often there is significant swelling around the ankle following this type of injury. There is relatively limited soft tissue around the ankle. This can make the tissue scarred and can predispose to wound healing problems.
- Nerve injuries: There are five nerves that run across the ankle and any of these may be irritated, leading to numbness or a burning sensation over the nerve distribution.
- Blood clotting
- Painful retained hardware. It may be necessary to remove painful hardware once the bones have healed adequately.
Edited July 3, 2017