Pilon Fracture: Causes, Symptoms, Treatment and Cost

A pilon fracture is a type of fracture that occurs when the lower end of the tibia, or shinbone, is severely damaged by a high energy force. Pilon fractures are considered to be one of the most severe and complex types of lower limb fractures.

There are several types of pilon fractures, including:-

• Closed Pilon Fracture: This type of fracture occurs when the bones remain within the skin after the trauma. It generally requires casting or physical therapy to heal properly.
• Open Pilon Fracture: This type of fracture occurs when the bone(s) breaks through the skin and is exposed to air and potential infection from outside sources.
• Comminuted Pilon Fracture: This type of fracture involves multiple pieces that are scattered throughout the area, making treatment more complicated and potentially requiring surgical intervention to realign them properly before healing can occur.
• Spiral Pilon Fracture: A spiral pilon fracture typically occurs when an twisting force is applied over a long period or due to a single blow causing multiple pieces along one plane which causes it to twist and explode apart into multiple sections quickly.

Pilon fractures can occur due to high-energy trauma, such as motor vehicle accident or falling from a height. They result from impact forces that compress and twist the ankle joint, leading to spiral or comminuted fractures of the distal part of the tibia (shinbone).

• Pain, inflammation or swelling and tenderness in the foot and ankle area.
• Difficulty bearing weight on the affected foot.
• Bruising around the affected area.
• Deformity or misalignment of the bone.
• Loss of range of movement in the foot.

• Wear protective gear while engaging in high-impact or contact sports.
• Use comfortable footwear while doing running or participating in any sports.
• Avoid involvement in activities with a high risk of ankle trauma, such as mountain biking or skiing.
• Strengthen lower leg muscles to ensure balanced, symmetrical muscle development and reduce the risk of an ankle injury.
• Stretch prior to strenuous exercise and activities to improve your flexibility and range of motion, which can also help protect your ankle from injury.

• X-rays: X-rays are typically used to diagnose a Pilon fracture, as they can reveal any fractures, displacement of the bones, and tell-tale signs of fractures such as bony debris around the fractured area.
• Magnetic resonance imaging (MRI): MRI is very useful for detecting a Pilon fracture. MRI scans allow for detailed images of the bones to be obtained, so that the size and location of the fracture can be accurately determined.
• CT scans: CT scans allow for detailed evaluation of the bone structure, including alignment. Fractured bones may often be visualized on CT scans due to their varying densities. By assessing the displacement and orientation of the fracture fragments, the severity of the injury is determined.
• Bone scans: Bone scans are a type of imaging test that use a type of x-ray technology to produce detailed images of bones and the surrounding soft tissues. By using bone scans, doctors can evaluate the severity or presence of a bone fracture along with other associated conditions that may be present, such as infection or tumor.

• Joint stiffness: As a result of the trauma, the joint can become stiff, resulting in decreased ROM and impaired function.
• Impaired sensation: Nerves around the fracture can be damaged, resulting in sensory deficits such as numbness and tingling.
• Infection: Infection at or near the fracture site can occur due to bacteria entering through open wounds or breaks in the skin layer.
• Non-union/mal-union: In cases where there is a disturbance in bone healing or inadequate fixation, fractures may fail to heal properly leading to deformity & pain in joints during motion.
• Posttraumatic arthritis: If proper fixation of fracture is not attained then it may lead to post traumatic arthritis causing erosion of bone cartilage & changes in bone architecture & cause pain during intense activities.

• Apply warm oil mixed with herbs beneficial in fractures such as Ashwagandha, Guggul and Methi (fenugreek) on the affected area to reduce pain, swelling and stiffness.
• Massage the affected area with warm clarified butter (Ghee) of cow milk twice a day to reduce inflammation and associated pain.
• Wrap a cotton bandage tightly around the fractured area followed by plaster-of paris cast for providing support when walking or doing simple activities.
• Consume 1-2 cups of cooked oats along with milk daily for adding adequate calcium and other minerals for strengthening bones and recovery from fracture wounds faster.
• Prepare a decoction by boiling 1 teaspoon of chitrak fruit powder in 2 cups of water until reduced to half, then cool it down before applying it as an external fomentation on the fracture spot to reduce inflammation and promote faster healing of broken bones.

• It is important to eat a balanced diet when recovering from a pilon fracture. Foods that are rich in lean proteins, vegetables and healthy fats can help the body to heal efficiently.
• Foods that are rich in calcium, vit D and omega-3 fatty acids are a very important source for strengthening the bones; these include fish, nuts, seeds and dark leafy greens like kale or spinach.
• Protein helps to build new muscle and repair tissues damaged during the fracture; sources of protein include beans, tofu, eggs, chicken and dairy products like yogurt and cottage cheese.
• It is essential to stay hydrated after sustaining a pilon fracture; aim for 8–10 cups of water per day or nutritious fluids like vegetable juices or smoothies with plenty of fruits and veggies.

• High-sodium foods: Foods high in sodium (such as salty snacks, canned soups, frozen dinners and processed meats) can cause increased swelling around the fracture site and delay healing.
• Drinks and foods rich in sugar: As sugar can elivate inflammation in the body which can interfere with healing.
• Alcohol: Consuming alcohol can weaken bones, making them more prone to fractures. It may also interact with medications used to treat Pilon fractures, such as pain relievers or antibiotics.
• Unsaturated fats: Fats found in deep-fried or processed foods increase inflammation and make the healing process more difficult for Pilon fractures.
• Dairy products: Dairy products may lead to an increase in swelling around the fracture site and slow healing time.

• Closed reduction and Plaster casting: The most common treatment for a Pilon fracture is closed reduction and plaster casting. This involves the doctor positioning the bone back into its normal alignment, followed by the application of a plaster cast to keep the bone in place while it heals.
• Physical therapy: Physical therapy for a pilon fracture is essential to help the patient recover and regain full range of motion, strength, balance and function. Physical therapy interventions may include a range of motion exercises, joint mobility exercises, flexibility and balance exercises, etc.
• Internal fixation: This involves stabilizing the bone with plates and screws placed internally to aid in healing.
• External fixation: This technique involves affixing pins or screws externally to the bone, connected by an external frame, to provide protection and stability while the bone heals.
• Intramedullary nail fixation: This involves insertion of a metal rod called an intramedullary nail into the hollow core of the bone that runs its length in order to provide stability while the fracture heals.
• Osteotomy: This is a surgical procedure that cuts bones, allowing them to be manipulated into optimal alignment and realignment before securing them in place with screws or plates for proper healing.

To treat the injury, it is recommended that the patient seek out an orthopedic surgeon or an orthopedic trauma specialist.

The doctor will do a physical examination to diagnose the fracture and determine its severity before deciding on a course of treatment.

• Analgesics: These are medications like acetaminophen and ibuprofen, which help in reducing pain and inflammation.
• Antibiotics: Antibiotics are used to treat or prevent infections on the fracture site. Some of the common antibiotics used for Pilon fractures include ciprofloxacin, amoxicillin and clindamycin.
• Corticosteroids: These are commonly given in the form of injections at the fracture site to reduce inflammation and swelling of tissue surrounding the bone. Examples of corticosteroids used for Pilon fractures include dexamethasone, methylprednisolone, and triamcinolone.
• Muscle relaxants: These help relieve spasms and pain in muscles that have been strained during a fracture healing period by relaxing them so they can more easily heal themselves more quickly. Common muscle relaxants used for Pilon fracture patients include cyclobenzaprine, carisoprodol, baclofen, and tizanidine.

Recovery from a Pilon fracture typically takes 6-12 months and usually involves a combination of treatments such as physical therapy, medications, and surgery if necessary.

The cost for a Pilon fracture treatment in India can vary depending on several factors, such as the complexity of the fracture, the hospital and surgeon's fees, medication and other associated costs. Generally however, it can range anywhere from 25000-50000 INR (approximate 350-700 USD) for basic surgery. Additionally, post-surgical physical therapy may be needed which will further add to this cost.

• Pain: Initially high pain due to fracture, gradually improving with treatment.
• Loss of range of motion: Stiffness and limited joint movement during treatment, full range restored after recovery.
• Swelling: Swelling and bruising may occur around the fracture site during treatment and can persist for some time afterward.
• Instability: When bones or joints are not properly aligned, there may result in instability or disruption of normal joint function and stability.
• Infection Risk: Surgery performed to treat fractures can result in an increased risk of infection at the wound site requiring antibiotics or other interventions to manage the infection effectively.

If you are going through any of the complications relating to pilon fracture then you should consult a trusted doctor nearby as they can cause complications like 'joint stiffness, impaired sensation, infection' if not treated on time in which treatment course can vary from a few months to years depending on the severity of the patient's situation.