Presentation
Brought in by friend after a fall off ladder, landing on left foot.
Patient Data
Spiral fractures of the distal tibial and fibular metadiaphyses. Comminuted distal fibular fracture. The distal segments demonstrate up to 8 mm lateral displacement and mild lateral angulation. The distal tibiofibular joint is not widened, and mortise alignment appears normal.
Comminuted, oblique fracture of distal fibula is mildly displaced. Comminuted, displaced intra-articular fracture of distal tibia is also noted. Left ankle is immobilized in a plaster back slab.
Conclusion
Comminuted, mildly displaced fractures of distal tibia and fibula.
No hardware complication. Alignment near anatomical. Ankle mortise appears congruent.
Case Discussion
More specifically this is called a pilon fracture, type C 1,2. These fractures involve the distal tibia and its articular surface. Like this patient, pilon fractures usually occur from high-energy trauma leading to axial loading or rotation, therefore, they are often comminuted 2. Comminuted fracture is where the bone breaks into more than 2 pieces.
This patient required an ORIF due to instability. Most pilon fracture require either ORIF or external fixation.
Remember to complete a CT with spiral fractures involving the distal tibia, especially if they are comminuted fractures. Posterior malleolus fracture occurs frequently with this injury and maybe missed in plain x-ray 3.
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