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broken ankle

Pilon Fracture: The Severe Ankle Injury You Should Hope You Never Have

By: Jason Rudolph, MD   February 4, 2019

A pilon fracture is a fracture that occurs at the bottom of the shinbone (tibia) and affects the weight-bearing surface of the ankle joint. Commonly, the fibula bone in the ankle is broken as well. Many pilon fractures occur due to high energy injuries such as motor vehicle accidents, falls from a height, or high-velocity sports injuries such as falling when skiing.

(If you ever fracture or sprain your ankle—or have any other sort of orthopedic injury—come to our walk-in Injury Center, where you can see an orthopedic specialist without an appointment!)

You can expect the same symptoms as you would for other severe fractures—severe pain, swelling, bruising, tenderness to touch, inability to bear weight, and, potentially, deformity at the injured site.


The majority of the time, your doctor will use an X-ray to evaluate the fracture. Sometimes a CT scan (essentially a three-dimensional X-ray of the ankle) is necessary in order to understand the complexity of the injury.

Non-Surgical Treatment

Fractures are only treated non-surgically in cases of low-impact injuries, where the bones are perfectly aligned. The nonsurgical treatments would be casting until the bones are healed, followed by outpatient physical therapy to regain motion to the ankle joint.

Surgical Treatment

The majority of the time, pilon fractures are severe enough with displaced fracture fragments involving the ankle joint that they require surgical intervention.

Sometimes surgery is performed immediately, but it may be necessary to wait if there is severe swelling. If surgery is deferred, your surgeon may use an external fixator or pins and rods outside of the leg to immobilize the ankle for a short period of time. The final surgery usually involves incisions and the placement of plates and screws. The extent of the fracture determines the extent of the surgery needed. If both the tibia and fibula are fractured, both bones will be fixated in most cases.

Risks of this surgery include stiffness, arthritis, or potentially deep-seated infection due to the severity of the fracture.


Patients may need to use a cast boot or brace after surgery. Outpatient physical therapy will begin once the skin is healed, usually two to six weeks after the final ankle surgery. Therapy is necessary to regain motion, decrease inflammation and swelling, as well to regain strength in the ankle.


Long-term outcomes really depend on the severity of the injury. There’s a good chance that many people will be able to fully return to their work and recreational activities at their pre-injury level. However, if you are in a high-demand manual job or participate in a high-impact recreational activity such as skiing or football, there is a possibility you won’t be able to participate at the same level as before.

Dr. Jason Rudolph is an orthopedic surgeon at Coordinated Health who specializes in foot and ankle procedures.

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