An external fixator may be applied to protect your foot until it is safe to perform a second surgery to repair the fracture. You may limp for several months after your fracture because of stiffness, discomfort, and weakness. I have no idea what to expect as time goes on. I’ll be non-weight bearing for at least another month he thinks, but I start basic PT next week. X-rays. That is what I’ve learned. Pilon fracture with bones thru the side of my ankle. Splints and casts. Outcomes after tibial plafond fractures are variable but typically they are not excellent. if so what degree and how did that effect you? Long-term patient-reported outcomes after operative treatment of pilon fractures reveal impaired functionality and lower HRQoL compared to an uninjured reference population. I almost cried. As you transition to wearing regular shoes, you will gradually stop wearing your brace. With pilon fractures, there can be total cartilage death after 6 months. Your doctor may apply an external fixator to hold your pilon fracture in place and stabilize your ankle until your second surgery can take place. I’m also an avid cyclist (my injury happened in cyclocross training), so happy at least to see you’re cycling OK. Just requested to follow you on Strava. Says too early to tell on cartilage, but my injury was mostly above the ankle joint so he doesn’t think I’ll be as bad off as some pilon fractures that “explode” the ankle joint. I can't wait to get back to strength training and skateboarding in a couple of months, and I'll be back vlogging every other day. The external fixator also helps to restore proper limb length and provides stability. Sunsets are just as pretty post pilon fracture, In fact…I’m glad to be alive. Please note that some fractures can give no symptoms or symptoms can be only minor. This article addresses pilon fractures—a specific type of fracture that occurs in the lower leg near the ankle. Will I develop arthritis or any other complications. Posttraumatic arthritis is a type of arthritis that develops after an injury. To help you maximize your abilities, your doctor and/or physical therapist will guide you in a slow progression to more vigorous movement. In this operation, your doctor makes small incisions into the skin and inserts metal pins through the bones. Glad for what I can do. … Ankle stiffness is very common after a pilon fracture. Her first words were “you’ve lost the joint space, the cartilage is gone. Be sure to ask questions if you have any. With pilon fractures, there can be total cartilage death after 6 months. Pilon fractures are often severe injuries that can permanently affect the ankle joint. Over time have you been able to stand on the pedals more and more? Doctors have seen an increase in pilon fractures since the introduction of air bags in motor vehicles. By delaying surgery in severe injuries, doctors have continued to decrease the risk of infection and wound problems. Hi renee my names natalie & Im also at the 14 week mark on my pilon fracture. Some degree of posttraumatic arthritis occurs in about half of all patients with pilon fractures. Some patients with posttraumatic arthritis may need further surgery to relieve symptoms. Even when your bones heal normally, the cartilage protecting the bones can be damaged, leading to pain and stiffness over time. 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.) Determine whether you have sustained any other injuries by examining the rest of your body. I am having problems with circulation…. While air bags enable more people to survive high-speed car crashes, they do not protect the legs—so many of the survivors wind up with pilon fractures and other leg injuries. I remember I was one month in bed afterwards or at least keeping my foot above my heart, and so I had all the time I wanted to watch YouTube and play guitar and goof off on Facebook. Even after the fracture has mended, it can still take months for the muscles to regain enough strength so that a person can walk correctly. Wow I hope that your impact was light and you have good cartilage survival. Given physio and an Aircast 'walking boot' to wear but was still in agony and couldn't weight bear properly. 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. ( Log Out /  That is why x-ray should be done at first to have it clear. The lower ends of these bones make up part of the ankle. Your doctor will develop a treatment plan based on your individual symptoms. I’m dealing with both legs right now. My ankle feels pretty good with a brace and tape. Your doctor and nurses will work to reduce your pain, which can help you recover from surgery faster. Physical Therapy Guidelines for Ankle Fracture with Surgery This was written and developed by the therapists of MGH Physical Therapy Services. If I have to have surgery, what are the benefits and risks? For this reason, as the swelling in your ankle decreases, you may need frequent cast changes. Patients with pilon fractures usually experience immediate and severe pain. 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. In some cases, surgery may be necessary to get rid of an infection. A pilon fracture is a type of break of the shinbone (tibia) that happens near the ankle. Most patients are not able to put all of their weight on their injured ankle for 2 to 3 months. By 4 months after surgery, most patients no longer need a walking aid. Six months after cartilage is injured you get to see what is going to stay and what is going to dissolve. Most of the time, it includes breaks in both the tibia and fibula of the lower leg. This includes how to use the device to walk up and down stairs or to get into and out of a car. Specifically, they examined the risks of complication after surgery for severe ankle fractures. Your symptoms will continue to improve for up to 2 years after your injury. These impairments can make performing your normal everyday activities difficult or impossible. Opioid dependency and overdose have become critical public health issues in the U.S. This is very typical.” She went on to say that the impact of the initial injury (the talus bone ramming upward and shattering the plafond of the tibia, ripping the cartilage to pieces in the process) leads to cartilage death many months after. You will probably walk like a zombie in the first stages of walking again, but with rehab and practice, you will get much better at it and faster. You may have significant pain after your procedure, but pain medicines may help to relieve the pain. Patients may need to use a cast boot or brace after surgery. The displaced bone fragments will be repositioned (reduced) into their normal alignment and held in place with metal plates and screws. Certain social, demographic, and treatment variables seem to contribute to these poor outcomes. You may be able to bear weight between two to three months. If their injuries cause significant blood loss, it could lead to shock—a life-threatening condition that can result in organ failure. To provide effective support, your cast must correctly fit your ankle. Swelling occurs quickly and can be followed by bruising. Outpatient physical therapy will begin once the skin is healed, usually two to six weeks after the final ankle surgery. If your fibula is also broken, your doctor might first perform surgery to fix the fibular fracture and get your ankle back into place—and then apply an external fixator to hold your pilon fracture in place. The swelling is still very pronounced, and I am still am icing. A CT scan can provide valuable information about the severity of the fracture by helping your doctor see the fracture lines more clearly. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS Find an Orthopaedist program on this website. Medications are often prescribed for short-term pain relief after surgery. A broken ankle can severely limit your ability to perform basic functional tasks like running and walking. Ankle fractures and dislocations can be either simple—involving just one bone—or complex—involving multiple bones. For example, it may be difficult to bend it the same way, go up and down stairs, or climb a ladder. My ladder broke while I was taking down my life size gingerbread house….grrrrr, Fell off a ladder March 9 2020. I was riding 7-10 hours a week (5-6 days) before and hope I can get back to that eventually. She said my lack of dorsiflexion was from the bone at the front of the tibia hitting the talus, and that wasn’t going to stop happening through more physical therapy. Both the time of being able to stand unipedal on the injured side and to walk without crutches were significantly shorter in patients using WBs (WB, 2.6 weeks; PC, 4.5 weeks, p = 0.01; WB, 1.4 weeks; PC, 3.1 weeks, p = 0.03). As soon as your pain begins to improve, stop taking opioids. Symptoms include pain and inability to bear weight on the leg. If you have an external fixator, you may not be able to start moving your ankle until the external fixator is removed. When will I be able to start putting weight on my leg? X-rays provide images of dense structures, such as bone. Not to be a total downer, here is a story about things I CAN DO while hobbling around on this ankle.. https://www.strava.com/activities/413271549/embed/ddf196e6cd9d52343e4c9b9651d9dd63ba126def” target=”_blank”>Click here for a glimpse of the possibilities for those of us with a bad ankle. Performing surgery too soon increases your risk for infection or problems with your incision. However, for some patients, there is little pain and no need for further surgery. It is very common to have difficulty bending your ankle as far back as you were able to before your injury. Because of the energy required to cause a pilon fracture, patients may have other injuries that require treatment as well. It is important to tell you doctor if you have pain in other parts of your body. If you also had damaged tendons or ligaments, then those may take longer to heal. Luckily my daughter works for a group of orthopedic doctors. Most of the time, it involves breaks in both the tibia and fibula of the lower leg. During this time, you will need to return regularly for follow-up x-rays to make sure your ankle remains stable. Talk to your healthcare provider about what you can expect after your surgery. No weight on it till end of June. It may also be recommended for patients who are unable to walk or patients with very serious medical problems who may not be able to tolerate surgery. The talus is a small foot bone that works as a hinge between the tibia and fibula. Walking. I got 2 plates (one each tib/fib), 14 screws, 3 incisions and I think it took them about 3 hours. The external fixator is usually removed after the plates and screws have been placed. The term "pilon" comes from the French word for pestle. Many pilon fractures require surgery but, rarely, some stable fractures can be treated nonsurgically. In some cases (those luckier than me) the cartilage survives enough t allow pain-free walking and much normal use of the ankle. If your skin and bone are severely damaged, making large incisions to insert plates and screws may injure your skin further. All rights reserved. In the majority of cases, your ankle will not be the same as it was before your injury. The amount each piece is out of place (displaced). The term “pilon” comes from the French word for … Talk to your doctor if your pain has not begun to improve within a few days of your surgery. 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. Eric, Almost two years post surgery. Walking with crutches is the first step toward rehabilitation. Was hit by a car 2 days ago and have fractured lower tibia in two places and lower fibula in three places. In some cases, nerves may be injured at the same time that the bone is broken. Recovery depends on the type, location, complexity and treatment. Urgent treatment is required to prevent infection. Whether or not your doctor recommends surgery often depends on how out of place (displaced) the fractured pieces of bone are. 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. What happens after a tibia/fibula fracture open reduction and internal fixation? If you don’t get cartilage loss will be pacific, you must be proactive to have a good prognosis, good luck…. 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. In many pilon fractures, the bone may be crushed or split into several pieces due to the high-energy impact that caused the injury. After the fracture of the leg and its plaster cast removal, the most important concern of the patient is when will they resume walking. According to my doc and several others I have talked to. They say it’s because I am staying very active. Long healing or worsening is one of possible fracture symptoms. The tibia may break in one place or shatter into multiple pieces. Rotator Cuff and Shoulder Conditioning Program. 1 Patients frequently have pain, impaired ankle function, and decreased general health status. Post was not sent - check your email addresses! 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 most cases, your doctor will first apply a splint to hold your ankle in place. With this type of injury, the other bone in the lower leg, the fibula, is frequently broken as well. Your doctor may recommend that you use crutches, a cane, or a walker during this time. Went through the surgery and was bed-bound for another 4 weeks. Once the swelling goes down, he or she will replace the splint with a short leg cast. About Tibial Pilon Fractures; Pilon Blog. Change ), You are commenting using your Facebook account. I am so bummed. They often result in an obvious deformity of the ankle joint. It depends on the type and cause of the fracture (motor vehicle accident versus a fall, for example). Results. He or she will: Information from imaging studies will help your doctor decide whether surgery is required and will be important for surgical planning. A Pilon fracture is a severe injury involving the ankle joint. Thanks. I’m freaking out about these fat ugly ankles. Managing the pain is the first step. There were no patients with loss of reduction or nonunion. Posttraumatic Arthritis. A CT scan will also help your doctor plan your treatment. You may benefit from physical therapy after a broken ankle to help you fully recovery functional mobility and to return to your previous level o… Surgery to promote healing usually includes placing a bone graft in the fracture. The bone graft will come from either your own bone (autograft) or from a donor (allograft). Complications that may occur with pilon fractures include: Stiffness. Despite surgical management, outcomes are predictably poorly characterized by functional deficits secondary to pain and stiffness. Therapy is necessary to regain motion, decrease inflammation and swelling, as well to regain strength in the ankle. After you fracture a bone, a physical therapist may visit you in the hospital. A tibial pilon fracture is a break at the bottom or distal portion of the tibia, more commonly known as the shinbone. I’m dealing with both legs right now. Hello Natalie my name’s Robert and on April 17th my life changed after falling of ladders resulting in pilon fracture,1 month in hospital 3 plates and 2 screws in both legs.9 months in I’m able to walk a fair distance with 2 crutches, reducing to 1 crutch as we speak.swelling has gone down,both ankles look like they should.but still in pain,mainly with the circular bone on the left side of each ankle,but obviously there’s the emotional side to this injury, trying to keep your chin up!! Pilon fractures most often result from high-energy trauma such as a car or motorcycle accident, fall from a height, or skiing accident. During this time, your doctor may recommend that you use crutches or a walker. To fully evaluate your fracture, your doctor may recommend an x-ray. Many types of medicines are available to help manage pain, including opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), and local anesthetics. Posted on November 9, 2015. by pilonzach. Pilon fractures vary. Right after the injury, you may or may not be able to walk or place weight on the ankle. Today I became 100% weight bearing. To fully evaluate your fracture, your doctor may recommend an x-ray (left), a CT scan (center), or a three-dimensional CT scan (right). A pilon fracture is a type of break of the shinbone (tibia) that happens near the ankle. Certain social, demographic, and treatment variables seem to contribute to these poor outcomes. Examine your lower leg and ankle, looking for cuts from the injury and gently pushing on different areas to see if it hurts. Once you are allowed to start moving your ankle, your doctor may place it in a removable cast or brace so that you can begin physical therapy. 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. Gradually increasing the number of steps walked will promote a healthy recovery after an ankle fracture 1. The bone of the lower part of the ankle joint (talus) is driven into the top of the ankle joint, causing a fracture to the weight bearing portion of t… The external fixator acts as a frame to help hold your ankle in a good position until a second surgery can be performed. Because the ankle and foot have been immobile for some time, strengthening the muscles that support the ankle and loosening up tight ligaments and muscles is necessary. Well… my surgeon walked in the room after I got out of x-ray and didn’t look very excited to see me. Trying to get my hands on a knee scooter now and hoping (is this insane?) 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. Depending on the severity of your pilon fracture, your recovery time may vary. Ankle is still swollen but I am able to move it around some. And not just severe ankle fractures but those requiring open reduction and internal fixation (ORIF). It is very common to have ankle stiffness after a pilon fracture. Typically, the fibula (the smaller ankle bone in the lower leg, parallel to the tibia) will also break when a tibial pilon fracture … Did they put a lot of hardware in there? If you have significant swelling or blisters, your doctor will delay your surgery until the swelling goes down. You will most likely be unable to bear weight on your ankle for up to 12 weeks after your injury. Further x rays showed that it STILL wasn't healed so the final resort was a synthetic bone-like cement injected into the fracture site. Mine happens march 9th 2020. Specific exercises will help improve the range of motion in your ankle. The amount of swelling will determine if and when surgery can be done. How quickly you begin movement will depend upon your doctor's preference, the type of fracture, and the treatment used for your injury. In the majority of cases, your ankle will not be the same as it was before your injury. Be aware that although opioids help relieve pain after surgery, they are a narcotic and can be addictive. Anyone else had any issues like this? It just takes time, which seems to … 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. This can result in infection. If your fracture does not heal properly, further surgery may be required. Nonsurgical treatment may be recommended for stable fractures in which the pieces of bone are not displaced or are minimally displaced. Check for swelling in your foot and ankle. This information is provided as an educational service and is not intended to serve as medical advice. Here are some questions you may wish to discuss with your doctor: AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. ….will get there. Fill in your details below or click an icon to log in: You are commenting using your WordPress.com account. Exercises to strengthen the supporting muscles will be added around 6 weeks after surgery. Pilon fractures are very painful and debilitating injuries. After your injury size gingerbread house….grrrrr, Fell off a ladder help to relieve.... 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