from the American Academy of Orthopaedic Surgeons, The amount and size of the broken bone fragments. Do I have any specific risks for not doing well? Patients with pilon fractures usually experience immediate and severe pain. However, for some patients, there is little pain and no need for further surgery. Did they put a lot of hardware in there? This type of fracture is particularly serious because, once the skin is broken, infection can occur in both the wound and the bone. To fully evaluate your fracture, your doctor may recommend an x-ray (left), a CT scan (center), or a three-dimensional CT scan (right). Results. This is a natural part of the healing process. She said ankle fusion or ankle replacement were her assumptions of my next procedure but that it wold not be her that did the surgery (Dr Herzog is a orthopedic trauma surgeon and the person who fixed me up when I came into the ER on March 6th.) In most cases, surgery is needed to restore the damaged bone to its normal position. when this happens I feel we are in a tunnel in a foreign country and learning as we go…. Your risk for arthritis is determined by a number of factors, including the number of broken pieces of bone, the degree of displacement, and whether the bones broke through your skin (open fracture). After surgery, you will feel some pain. I believe that’s on the long side, they thought it was going to be four or five hour surgery but there was a lot of little pieces when they got to working on me. As pilon fractures can have significant effects on a patient's life, patients should be counseled about the expected long-term outcomes to set realistic expectations. In some cases, surgery may be necessary to get rid of an infection. They often result in an obvious deformity of the ankle joint. Mine was 12 hours. If I have to have surgery, what are the benefits and risks? Plates and screws may be used to fix the break, as long as the skin and surrounding tissues are healthy. Luckily my daughter works for a group of orthopedic doctors. Because your ankle can continue to improve for up to 2 years, it is important to continue the exercises even after you have completed the formal physical therapy program. During this operation, the displaced bone fragments are first repositioned (reduced) into their normal alignment, and then held together with screws and metal plates attached to the outer surface of the bone. Good luck to all dealing with this. With pilon fractures, there can be total cartilage death after 6 months. When will I be able to start putting weight on my leg? Very rarely, the infection cannot be cleared and amputation may be required. Conclusions: At more than three years after the injury, pilon fractures can have persistent and devastating consequences on patients' health and well-being. Your doctor will closely monitor the healing of your fracture. The external fixator is usually removed after the plates and screws have been placed. that it will eventually allow me to do what had been a twice daily 10-15 minute walking portion of my commute in New York City. After the fracture of the leg and its plaster cast removal, the most important concern of the patient is when will they resume walking. A pilon fracture typically occurs as the result of a high-energy event, such as a car collision or fall from a height. Here are some questions you may wish to discuss with your doctor: AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. Most of the time, it involves breaks in both the tibia and fibula of the lower leg. I’m dealing with both legs right now. Painful plates and screws—patients who experience discomfort may choose to have their plates and screws removed after the bone has healed, Blood vessel or nerve damage—this may occur at the time of the injury or during surgery, Whether you have other injuries or medical problems. Exercises to strengthen the supporting muscles will be added around 6 weeks after surgery. Well… my surgeon walked in the room after I got out of x-ray and didn’t look very excited to see me. The tibia may break in one place or shatter into multiple pieces. X-rays. In this operation, your doctor makes small incisions into the skin and inserts metal pins through the bones. I was using crutches for 3 months. A CT scan will also help your doctor plan your treatment. Check for swelling in your foot and ankle. Your doctor may place your ankle in a splint until your surgery, or recommend that you have an initial smaller surgery to protect your ankle while waiting for the second surgery. The fracture involves the larger bone of the lower leg (tibia), and extends into the weight bearing surface of the ankle joint. Pilon or plafond fractures occur in the distal portion of the tibia. I got 2 plates (one each tib/fib), 14 screws, 3 incisions and I think it took them about 3 hours. To find in-depth information on ankle fractures, please read Ankle Fractures (Broken Ankle). If their injuries cause significant blood loss, it could lead to shock—a life-threatening condition that can result in organ failure. This will offer protection while your ankle continues to heal. A pilon fracture is a type of break that occurs at the bottom of the tibia (shinbone) and involves the weight-bearing surface of the ankle joint. I’m dealing with both legs right now. Change ), You are commenting using your Facebook account. It usually occurs following a significant force to the foot, such as a fall from a height or motor vehicle accident (MVA). It is important to tell you doctor if you have pain in other parts of your body. Physical Therapy Guidelines for Ankle Fracture with Surgery This was written and developed by the therapists of MGH Physical Therapy Services. Nonsurgical treatment may be recommended for stable fractures in which the pieces of bone are not displaced or are minimally displaced. He or she will: Information from imaging studies will help your doctor decide whether surgery is required and will be important for surgical planning. … I’m freaking out about these fat ugly ankles. This can result in infection. I have been studying up on ankle fusion and replacement, assuming that was where I’d eventually end up, and the downsides of those solutions had me very sad indeed. The external fixator also helps to restore proper limb length and provides stability. The swelling is still very pronounced, and I am still am icing. It sucks. Surgeon also thinks I ought to be able to begin light pedaling (I’m not going to call it cycling at that point) when I start weight-bearing – so I’m looking forward to that for both mind and body. However, if your job involves manual labor or if you participate in high-impact sports, you may not be able to return to the same level of activity as before your injury. Check your pulse at key points of the foot to be sure that there is a good blood supply to your foot and ankle. Fractures involving the joint surface called pilon fractures have a more conservative care plan after surgery. Symptoms include pain and inability to bear weight on the leg. Her first words were “you’ve lost the joint space, the cartilage is gone. X-rays provide images of dense structures, such as bone. I tried to convince her that I had some good results from PT, and massage, but she ignored me and said it was time I find a ankle specialist who was skilled in post-pilon fracture treatments, and explore my options. The term “pilon” comes from the French word for … Pilon fractures vary. This risk has been brought down to about 10% or less for patients with pilon fractures. How long was your surgery? After 6 weeks, your doctor may replace your cast with a removable brace. If your fracture does not heal properly, further surgery may be required. If you don’t get cartilage loss will be pacific, you must be proactive to have a good prognosis, good luck…. It just takes time, which seems to … Specific exercises will help improve the range of motion in your ankle. Most patients are not able to put all of their weight on their injured ankle for 2 to 3 months. I think this injury is worse babying and coming back onto full weight-bearing as slowly as possible and lots of physical therapy. Together, these three bones—tibia, fibula, and talus—make up the ankle joint. If you also had damaged tendons or ligaments, then those may take longer to heal. Performing surgery too soon increases your risk for infection or problems with your incision. These patients may also have additional injuries to the head, chest, abdomen, or legs. I received 3 plates and 20 screws. Ankle stiffness is very common after a pilon fracture. Your doctor may recommend that you use crutches, a cane, or a walker during this time. If there is a problem consult your ortho immediately. It is very common to have difficulty bending your ankle as far back as you were able to before your injury. Many pilon fractures require surgery but, rarely, some stable fractures can be treated nonsurgically. Waighing the pros and cons of operating while waiting for the swelling to go down. Posted on November 9, 2015. by pilonzach. As soon as your pain begins to improve, stop taking opioids. You may be able to bear weight between two to three months. Thanks. In many pilon fractures, the bone may be crushed or split into several pieces due to the high-energy impact that caused the injury. Well… my surgeon walked in the room after I got out of x-ray and didn’t look very excited to see me. A Pilon fracture is a severe injury involving the ankle joint. Today I became 100% weight bearing. As you transition to wearing regular shoes, you will gradually stop wearing your brace. Any advise? You may limp for several months after your fracture because of stiffness, discomfort, and weakness. Complications that may occur with pilon fractures include: Stiffness. Opioid dependency and overdose have become critical public health issues in the U.S. Medications are often prescribed for short-term pain relief after surgery. Not sure it constitutes a pilon fracture but orthopedic dr. says that surgery is needed because of the risk of mis alignment followed by arthritis and chronic pain. This website also contains material copyrighted by third parties. And not just severe ankle fractures but those requiring open reduction and internal fixation (ORIF). I am having problems with circulation…. Right after the injury, you may or may not be able to walk or place weight on the ankle. What do you mean proactive? You may have significant pain after your procedure, but pain medicines may help to relieve the pain. Unfortunately, the boot keeps my foot in one place and because of the difference between a normal left shoe and a right boot it hurts my back incredibly to walk much distance. While they fix the pain of walking, they are by no means the return to normalcy. Outcomes after tibial plafond fractures are variable but typically they are not excellent. In summary, this study does not demonstrate a clinical benefit in patients with gait derangements after pilon fracture at walking speeds. Specifically, they examined the risks of complication after surgery for severe ankle fractures. I am hopeful that I find some good news. The severity of the injury depends on several factors, including: If the bone breaks in such a way that bone fragments stick out through the skin or a wound penetrates down to the broken bone, the fracture is called an "open" or compound fracture. Some days I have pain and some I don’t. Sunsets are just as pretty post pilon fracture, In fact…I’m glad to be alive. Fill in your details below or click an icon to log in: You are commenting using your account. Your doctor may order a CT scan right away, or may wait until later in your treatment—after an external fixator is applied. More severe infections may require intravenous antibiotics for several weeks at a time. I am 14 weeks post surgery that resulted in 2 plates and 18 screws. Thus, we determined the clinical effects of routine hardware removal irrespective of the degree of hardware-related pain, especially in the perspective of patients’ daily activities. Despite surgical management, outcomes are predictably poorly characterized by functional deficits secondary to pain and stiffness. ( Log Out /  The pins project out of the skin and are attached to carbon fiber bars outside the skin. Once the swelling and blisters go away, your doctor can then fix your tibia bone with metal plates and screws. Swelling occurs quickly and can be followed by bruising. Hi renee my names natalie & Im also at the 14 week mark on my pilon fracture. Change ), You are commenting using your Google account. 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