Pilon Ankle Fractures

by John M. Schuberth, DPM
Chief, Foot and Ankle Surgery
Kaiser Foundation Hospital
San Francisco, CA

One of the most devastating injuries that podiatry residents are exposed to is the Pilon fracture. Jack Schuberth handles this topic expertly because he is a master foot and ankle surgeon. As I viewed the lecture, I felt compelled to add a warning, “Do not try this on your own without years of experience in traumatology, AO Fixation and fracture physics”. Dr. Schuberth warns us “ this is not an injury that should be cared for by a minor leaguer”.

Experts on this topic know that despite their best efforts, complications will undoubtedly occur. High-energy injuries such as these are associated with significantly higher infection rates, compartment syndrome, avascular necrosis, malunions and massive damage to the soft tissue structures.

In the lecture, we learn that the mechanism for this devastating injury is a fall from a substantial height in the overwhelming majority of instances. The resultant axial load drives the talus into the distal tibial plafond, causing severe disruption and compression of the distal tibial metaphysis. Massive communition and impaction of the cartilaginous surfaces is quite common. Unfortunately, damage to the articular cartilage is undetectable so there isn’t much that can be done about it. Dr. Schuberth warns us to be alert to concomitant fractures of the spine, femur, pelvis and upper extremities.

In the lecture Dr. Schuberth discusses the three basic components that must be addressed in this type of injury. These are, the joint, the alignment and the defect. AO fixation revolutionized the care of these injuries because it allowed for anatomic reduction of the distal tibia. The new external fixation frames took treatment of these injuries another major step forward because they allow for fixation, stabilization and distraction without the need for massive exposure. Dr. Schuberth urges us not to be in a hurry. Use Steinman pins or a rigid fixator to temporarily stabilize the limb and allow for soft tissue quiescence. Then use the techniques specifically designed to repair the injury when the limb is stable.

This lecture takes us directly to the forefront of cutting edge trauma surgery.

Dr. Schuberth was one of the first nationally recognized educators to step forward and see the value of internet education for podiatry residents. The entire community owes him a debt of gratitude for this and the many other contributions he has made to podiatric education.

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