Pilon Fracture Surgery

A Pilon fracture is a high-energy fracture that oftentimes causes severe damage to the joint (articular) surface. Although arthritis is common after these injuries, surgery is performed to decrease the severity of the arthritis and to improve the results of potential future procedures such as fusion or replacement. Due to the nature of the injury, healing after a Pilon fracture is routinely delayed in comparison to typical ankle injuries. We take a closer look at the standard procedure for addressing a Pilon fracture with a surgical operation.

What Happens Before Pilon Fracture Surgery?

You’ll be given specific instructions on how to prepare for your upcoming operation by the surgical center. Depending on how the injury occurred, you may be taken to surgery shortly after the injury occurred. Before surgery begins, you will be given antibiotics to help prevent infection.

What Happens During Pilon Fracture Surgery?

You will be given general anesthesia at the outset to ensure that you do not feel anything during the procedure. A tourniquet will be placed around your thigh, and incisions may be made along the front, lateral, and medial sides of the ankle. Small incisions are made to minimize injury and percutaneously fix the fracture. A local bone graft or bone graft substitute may be used to help with healing. The fractured bones are put back together and plates, screws, or wires are used to set the bones in place. An external fixator (pins through the skin attached to metal bars outside the skin) is commonly applied. X-Rays taken during the surgery confirm the correction. The wounds are then closed with staples, and you’ll be moved to a recovery room until you wake up from the anesthesia.

What Happens After Pilon Fracture Surgery?

You will be permitted to leave the post-anesthesia center once your anesthesiologist is satisfied that you have recovered. Patients with more severe injuries require an inpatient stay. During this recovery time your family member may take your prescription to the nearest pharmacy. You will be given crutches. Take your narcotic pain control medications during this early post-operative period. Remember, post operative pain is much easier to control with prevention. Call to schedule your post-operative visit at two weeks when you feel able. 

 

Pilon Fracture General Recovery Timeline

This timeline is a general guideline. Your post-operative course may vary.

Elevation	23 hours / day for 10 days; swelling may last over 4 months.
Motion	Move your ankle and toes when the block resolves. This will decrease pain and swelling, and improve healing.
Walking	No weight bearing for at least 8 and often 12 weeks.
Bathing	Keep cast dry. Use a Xerosox. There are no restrictions after the cast is removed. If you have an External fixator, wash daily and follow instructions.
Dressing	Please see pin care instructions if you have an external fixator otherwise, keep casts clean and dry.
Pain Control	Expect to use strong narcotics for the first 3-5 days. Wean off as soon as you are comfortable using Tylenol or Ultram (Rx only).
Work	Return depends on specific demands. It is safe to return to sedentary work at 10 days post-op. Return to heavy labor will take at least 3 months.
Driving	Patients with left foot surgery may drive an automatic transmission. Patients with right foot surgery must wait until healing is adequate and they feel safe.
	Routine Clinic Visits
2 weeks	XR, Cast and suture or staple removal
6 weeks	XR, Cast change. The time to return for your next visit varies significantly with type of injury
10 weeks	XR: Fracture brace applied. XR If necessary, your external fixator may be removed in the office or under sedation in an operating room.
3-6 months	Strength improves over then next year. Minimal feelings of discomfort may linger, your overall comfort level improves over a year.
**********	If at any time during your post-operative period you notice any drainage or foul odor from your incision, a temperature of more than 100.4 degrees and/or increased swelling or tenderness, you should contact our office.