Understanding your injury

A pilon fracture breaks the lower tibia at the ankle joint surface. It may follow a fall from height, a collision or a lower-energy injury in weaker bone. The joint surface, bone above it and skin can all be damaged. Examination checks wounds, swelling, circulation, nerves and other injuries. X-rays and usually a CT scan help plan treatment, often after initial stabilisation.

Treatment and the procedure

Some well-aligned fractures can be treated in a cast. Displaced or unstable injuries commonly need reconstruction. Treatment may be staged: a temporary external frame holds the ankle aligned while damaged skin and swelling settle, followed by plates and screws when appropriate. A frame can also be definitive treatment. Severe tissue loss may require plastic surgery input; a joint surface that cannot be reconstructed may lead to discussion of fusion. These are individual decisions.

Benefits, risks and expectations

If surgery is planned, discuss bleeding, anaesthetic risks and complex regional pain syndrome as well as the risks specific to your injury. Your general health and the extent of surgery affect your personal risk.

The aim is to restore alignment and stability while protecting the skin and blood supply. Surgery cannot reverse all cartilage damage from the original injury.
Risks include wound breakdown, infection, nerve or vessel injury, delayed healing, nonunion, malunion and further operations. Serious infection or tissue damage can threaten the limb.
Persistent stiffness, swelling, pain and post-traumatic arthritis are important possibilities. Recovery may be prolonged and demanding work or sport may remain difficult.

Rehabilitation and aftercare

Follow the surgeon's written weight-bearing and movement restrictions. Do not use a routine ankle-fracture schedule for a pilon injury. Keep wound and frame appointments; use the pin-site care method taught by your team. Physiotherapy works on permitted motion, muscle strength, safe transfers and walking as healing allows. Plan support at home and discuss work adjustments. Further imaging guides progression rather than a fixed calendar.

When to get urgent help

Go to A&E for sudden severe pain or a cold, discoloured or increasingly numb foot. Report spreading redness, discharge, fever or a painful pin site promptly.
New calf pain or swelling needs urgent assessment. Chest pain or breathlessness requires 999.

Your consultation

Ask whether treatment will be staged, what the CT shows, whether bone grafting or soft-tissue reconstruction may be needed and which outcome is realistic. Your consent discussion is specific to the proposed operation.

Your consent discussion

Use the patient pack to record your priorities, the proposed procedure, its alternatives, the benefits you hope for and risks that matter to you. A clinician will discuss your individual circumstances and complete the appropriate hospital consent process with you.

Reading or downloading a guide does not give consent. You can ask further questions, decline treatment or change your mind before the procedure.

Pilon fractures