Tibial Pilon fractures. A challenge for Orthopedics surgeons

A tibial Pilon fracture is a fracture of the distal metaphysis of the tibia that extends to the ankle joint. Initially described in 1911 by Étienne Destot, who used the French word “Pilon” to describe the mechanical interaction between the distal end of the tibia and the talus. The term “Pilon” (mortar) refers to the traumatic mechanism involved in these fractures, which is the generation of force vectors from the tibial tip in an axial direction on the talus as a result of the energy released during trauma.[1,2] Although uncommon, they pose a major challenge to traumatologists; this is due to the possible presence of associated soft tissue injuries and the great difficulty of their treatment due to the diversity of possible fracture lines. Lower extremity trauma is considered one of the most serious and compromising injuries to this region of the human body [3].

This injury accounts for less than 1% of all lower extremity fractures, and its causes include falls from heights, car accidents, accidents during sports, and other everyday accidents [4]. The purpose of this review article is to analyze the most relevant data regarding these fractures and their difficulty in treating them.

Search strategy and selection criteria:

References were identified by searching PubMed, Google Scholar, and Elsevier for publications published between 2013 and 2025 in English using the terms “tibial Pilon fractures,” “fractures of the distal end of the tibia,” and “metaphyseal-articular fractures of the distal tibia.” Articles accessible either freely or through the Clinical Key and Hinari services were also reviewed.

Development:

Tibial Pilon fractures are rare, accounting for 3% to 10% of all tibial fractures and less than 1% of lower extremity fractures. They comprise 2% to 5% of all tibiotalar-fibular joint fractures, depending on the criteria. Men suffer these injuries more frequently than women, and most injuries occur between the fourth and fifth decades of life, with a bimodal peak between 25 and 50 years of age. In 75% to 90% of cases, the fibula is fractured. Tibial Pilon fractures with an intact fibula occur in 10–25% of cases, and recent studies have suggested that tibial Pilon fractures are likely less comminated and less severe when the fibula remains intact [5–7].

Tibial Pilon fractures result from high-energy trauma with a large axial force, which causes the tibial plafond to rupture over the talus. [8,9] The distal tibia has a relatively thin soft tissue envelope that is prone to injury in high-energy trauma. The high energy surrounding these fractures also causes severe damage to the surrounding soft tissues [10,11]. Several classification systems for tibial Pilon fractures have been described. Lauge Hansen,[12] Rüedi and Allgöwer,[13] Ovadia and Beals,[14] AO/OTA,[15] Topliss,[16] and Leonetti and Tigani,[17] based on CT studies, is the most widely used currently. Tibial Pilon fractures are recognized as some of the most difficult fractures to treat and are associated with a high incidence of posttraumatic osteoarthritis later in life. Surgical treatment should be optimal, as should postoperative rehabilitation. Deformity, functional impairment, and edema are classic clinical signs of most fractures, and imaging evaluation is important. Imaging should not only consider the distal tibia, ankle, and mortise, but also include other sites.

Tibial Pilon fractures are recognized as among the most difficult fractures to treat. A proper understanding of the fracture mechanism and its correct classification constitute the basis for appropriate management, taking into account the soft tissue status of the injured area.

None.

No conflict of interest.

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