Download PDF
Semin Musculoskelet Radiol 2022; 26(06): 623-634
DOI: 10.1055/s-0042-1760122
Review Article

Presurgical Perspective and Postsurgical Evaluation of Tibial Pilon Fractures

Alexandra Piña-Rivas
1   Department of Radiology, Hospital de La Ribera, Valencia, Spain
,
Raul Mut-Pons
1   Department of Radiology, Hospital de La Ribera, Valencia, Spain
,
Eva Llopis
1   Department of Radiology, Hospital de La Ribera, Valencia, Spain
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

Tibial pilon fractures represent only a small percentage of all fractures of the lower limb. But they are a feared entity, both for the interpreting radiologist and the treating surgeon and, ultimately, for the patient because they involve the weight-bearing area of the joint and often have associated soft tissue injury. These factors make them technically challenging, with poor clinical and functional results in many patients, even when a perfect joint reduction is achieved. Presurgical evaluation with computed tomography and individualized staged management is critical for the prognosis, a definitive treatment strategy, and the prevention of future complications.

Keywords

fracture - tibial pilon - computed tomography - soft tissues

Supplementary Material



Publication History

Article published online:
15 February 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 McCann PA, Jackson M, Mitchell ST, Atkins RM. Complications of definitive open reduction and internal fixation of pilon fractures of the distal tibia. Int Orthop 2011; 35 (03) 413-418
    CrossrefPubMedGoogle Scholar
  • 2 Borrelli Jr J, Ellis E. Pilon fractures: assessment and treatment. Orthop Clin North Am 2002; 33 (01) 231-245 , x
    CrossrefPubMedGoogle Scholar
  • 3 Zelle BA, Dang KH, Ornell SS. High-energy tibial pilon fractures: an instructional review. Int Orthop 2019; 43 (08) 1939-1950
    CrossrefPubMedGoogle Scholar
  • 4 Mauffrey C, Vasario G, Battiston B, Lewis C, Beazley J, Seligson D. Tibial pilon fractures: a review of incidence, diagnosis, treatment, and complications. Acta Orthop Belg 2011; 77 (04) 432-440
    PubMedGoogle Scholar
  • 5 Aitken GK, Bourne RB, Finlay JB, Rorabeck CH, Andreae PR. Indentation stiffness of the cancellous bone in the distal human tibia. Clin Orthop Relat Res 1985; (201) 264-270
    PubMedGoogle Scholar
  • 6 Bastias C, Lagos L. New principles in pilon fracture management: revisiting Rüedi and Allgöwer Concepts. Foot Ankle Clin 2020; 25 (04) 505-521
    CrossrefPubMedGoogle Scholar
  • 7 Bear J, Rollick N, Helfet D. Evolution in management of tibial pilon fractures. Curr Rev Musculoskelet Med 2018; 11 (04) 537-545
    CrossrefPubMedGoogle Scholar
  • 8 Dujardin F, Abdulmutalib H, Tobenas AC. Total fractures of the tibial pilon. Orthop Traumatol Surg Res 2014; 100 (1, Suppl): S65-S74
    CrossrefPubMedGoogle Scholar
  • 9 Tomás-Hernández J. High-energy pilon fractures management: State of the art. EFORT Open Rev 2017; 1 (10) 354-361
    CrossrefPubMedGoogle Scholar
  • 10 Sirkin MS. Plating of tibial pilon fractures. Am J Orthop 2007; 36 (12, Suppl 2): 13-17
    PubMedGoogle Scholar
  • 11 Landeras A, Gallardo E, García-Barredo Pérez I, Perez Nuñez A, Errasti S. Tibial pilon fractures: imaging evaluation. Paper presented at: Annual Congress of the Spanish Society of Medical Radiology; May 22–25, 2014; Oviedo, Spain
    PubMedGoogle Scholar
  • 12 Leonetti D, Tigani D. Pilon fractures: a new classification system based on CT-scan. Injury 2017; 48 (10) 2311-2317
    CrossrefPubMedGoogle Scholar
  • 13 Palma J, Villa A, Mery P. et al. A new classification system for pilon fractures based on CT scan: an independent interobserver and intraobserver agreement evaluation. J Am Acad Orthop Surg 2020; 28 (05) 208-213
    CrossrefPubMedGoogle Scholar
  • 14 Topliss CJ, Jackson M, Atkins RM. Anatomy of pilon fractures of the distal tibia. J Bone Joint Surg Br 2005; 87 (05) 692-697
    CrossrefPubMedGoogle Scholar
  • 15 Chen H, Cui X, Ma B, Rui Y, Li H. Staged procedure protocol based on the four-column concept in the treatment of AO/OTA type 43-C3.3 pilon fractures. J Int Med Res 2019; 47 (05) 2045-2055
    CrossrefPubMedGoogle Scholar
  • 16 Sivaloganathan S, Pedersen JB, Trompeter A, Sabri O. Pilon fractures: a review of current classifications and management of complex Pilon fractures. Orthop Trauma 2017; 31 (02) 133-138
    CrossrefPubMedGoogle Scholar
  • 17 Sirkin M, Sanders R, DiPasquale T, Herscovici Jr D. A staged protocol for soft tissue management in the treatment of complex pilon fractures. J Orthop Trauma 1999; 13 (02) 78-84
    CrossrefPubMedGoogle Scholar
  • 18 López-Prats F, Sirera J, Suso S. Fracturas del pilón tibial. Rev Esp Cir Ortop Traumatol 2004; 48 (06) 470-483
    PubMedGoogle Scholar
  • 19 Argüelles-Linares F, Mifsut-Miedes D, Gil-Albarova R. Alternatives for the treatment of complex tibial pilon fractures. [in Spanish]. Acta Ortop Mex 2014; 28 (05) 291-296
    PubMedGoogle Scholar
  • 20 Kottmeier SA, Madison RD, Divaris N. Pilon fracture: preventing complications. J Am Acad Orthop Surg 2018; 26 (18) 640-651
    CrossrefPubMedGoogle Scholar
  • 21 Dujardin C, Goldzak M, Simon P. Fractures du pilon tibial. EMC (Elsevier Masson SAS, Paris), Techniques chirurgicales - Orthopédie-Traumatologie 2009; 44: 878
    PubMedGoogle Scholar
  • 22 McFerran MA, Smith SW, Boulas HJ, Schwartz HS. Complications encountered in the treatment of pilon fractures. J Orthop Trauma 1992; 6 (02) 195-200
    CrossrefPubMedGoogle Scholar
  • 23 Patterson MJ, Cole JD. Two-staged delayed open reduction and internal fixation of severe pilon fractures. J Orthop Trauma 1999; 13 (02) 85-91
    CrossrefPubMedGoogle Scholar
  • 24 Rominger MB, Lukosch CJ, Bachmann GF. MR imaging of compartment syndrome of the lower leg: a case control study. Eur Radiol 2004; 14 (08) 1432-1439
    CrossrefPubMedGoogle Scholar
  • 25 Bong J, Bell D. Acute compartment syndrome. Reference article, Radiopaedia.org. Accessed March 23, 2022 at: https://doi.org/10.53347/rID-60854
    CrossrefPubMedGoogle Scholar
  • 26 Auer R, Riehl J. The incidence of deep vein thrombosis and pulmonary embolism after fracture of the tibia: an analysis of the National Trauma Databank. J Clin Orthop Trauma 2017; 8 (01) 38-44
    CrossrefPubMedGoogle Scholar
  • 27 Vicenti G, Bizzoca D, Scialpi L, De Carolis O, Carrozzo M, Moretti B. Malunions and nonunions following tibial malleolar and tibial plafond fractures: current concepts. Hospital Traumatologists of Italy (O.T.O.D.i.) 2020;34 (Special Issue on Trauma Meeting). Accessed March 23, 2022 at: https://www.loscalpellojournal.com/article/view/152
    PubMedGoogle Scholar
  • 28 Bell A, Templeman D, Weinlein JC. Nonunion of the femur and tibia: an update. Orthop Clin North Am 2016; 47 (02) 365-375
    CrossrefPubMedGoogle Scholar
  • 29 Chaudhary MM. Infected nonunion of tibia. Indian J Orthop 2017; 51 (03) 256-268
    CrossrefPubMedGoogle Scholar
  • 30 Calori GM, Phillips M, Jeetle S, Tagliabue L, Giannoudis PV. Classification of non-union: need for a new scoring system?. Injury 2008; 39 (Suppl. 02) S59-S63
    CrossrefPubMedGoogle Scholar
  • 31 Rammelt S, Zwipp H. Intra-articular osteotomy for correction of malunions and nonunions of the tibial Pilon. Foot Ankle Clin 2016; 21 (01) 63-76
    CrossrefPubMedGoogle Scholar
  • 32 Thordarson DB. Complications after treatment of tibial pilon fractures: prevention and management strategies. J Am Acad Orthop Surg 2000; 8 (04) 253-265
    CrossrefPubMedGoogle Scholar
  • 33 Fischer B, Mason LW. Reconstruction of severe ankle and pilon fracture malunions. Foot Ankle Clin 2020; 25 (02) 221-237
    CrossrefPubMedGoogle Scholar
  • 34 Williams TM, Nepola JV, DeCoster TA, Hurwitz SR, Dirschl DR, Marsh JL. Factors affecting outcome in tibial plafond fractures. Clin Orthop Relat Res 2004; (423) 93-98
    CrossrefPubMedGoogle Scholar
  • 35 Fernández O, Álvarez I, Betegón J, González J, Sánchez S. Fractures of the tibial pilon. Long-term functional results. Rev Española Cir Ortop Traumatol 2008; 52 (03) 152-160
    PubMedGoogle Scholar
  • 36 Delco ML, Kennedy JG, Bonassar LJ, Fortier LA. Post-traumatic osteoarthritis of the ankle: A distinct clinical entity requiring new research approaches. J Orthop Res 2017; 35 (03) 440-453
    CrossrefPubMedGoogle Scholar
  • 37 Pierannunzii L, De Bellis U, D'Imporzano M. The operative treatment of the tibial pilon fractures. Ital J Orthop Traumatol 2002; 25: 11-23
    PubMedGoogle Scholar
  • 38 Ratti C, Nordio A, Resmini G, Murena L. Post-traumatic complex regional pain syndrome: clinical features and epidemiology. Clin Cases Miner Bone Metab 2015; 12 (Suppl. 01) 11-16
    PubMedGoogle Scholar
  • 39 Aleman C, Cegarra F, Redondo M, Martínez N, Gonzalez G, Zevallos C. Complications of ankle fractures: management and imaging findings. Poster presented at: Annual Congress of the Spanish Society of Medical Radiology; May 24–28, 2012; Granada, Spain
    PubMedGoogle Scholar
  • 40 Eastman JG, Firoozabadi R, Benirschke SK, Barei DP, Dunbar RP. Entrapped posteromedial structures in pilon fractures. J Orthop Trauma 2014; 28 (09) 528-533
    CrossrefPubMedGoogle Scholar
  • 41 Primadi A, Kim BS, Lee KB. Tarsal tunnel syndrome after total ankle replacement—a report of 3 cases. Acta Orthop 2016; 87 (02) 205-206
    CrossrefPubMedGoogle Scholar
  • 42 Radswiki T, Baba Y. Tarsal tunnel syndrome. Reference article, Radiopaedia.org. Accessed March 20, 2022 at: https://radiopaedia.org/articles/tarsal-tunnel-syndrome?lang=us
    PubMedGoogle Scholar
  • 43 Li WJ, Li T, Sun X, Sun ZJ, Yang MH, Wu XB. Postoperative distal tibiofibular synostosis: radiographic characteristics and the influence on ankle mobility. [in Chinese]. Zhonghua Yi Xue Za Zhi 2019; 99 (21) 1621-1625
    PubMedGoogle Scholar