Jonathan Cluett, MD, is a board-certified orthopedic surgeon with subspecialty training in sports medicine and arthroscopic surgery.

Eva Umoh Asomugha, M D, is a board-certified orthopedic surgeon who specializes in all conditions involving the foot and ankle region. She is based in northern Virginia.

A tibial plafond fracture (also called a tibial pilon fracture) occurs at the end of the shin bone and involves the ankle joint. As is the case with tibial plateau fractures, these injuries occur close to the joint and must be treated with the cartilage surface of the ankle joint in mind.

Tibial plafond fractures occur just above the ankle joint and involve that critical cartilage surface of the ankle. The other major factor that must be considered with these injuries is the soft tissue around the ankle region. Even with proper treatment, there can be both short and long-term complications of ankle joint function. People who sustain a tibial plafond fracture are at high risk of developing accelerated ankle arthritis.

Because there are little muscle and skin surrounding the ankle joint, severe fractures of the tibial plafond can be problematic. If the soft tissues are too swollen and damaged, surgery may not be possible through these damaged tissues. In these cases, definitive surgery may be delayed until the swelling subsides and the soft tissue condition improves.

While the soft tissue is healing, the fractured bone and ankle joint will be immobilized. This may be done with the use of a cast, splint, or external fixator. An external fixator is a device placed surgically around the soft tissues that are swollen and damaged. The external fixator secures the bone both above and below the fracture while avoiding the soft tissue that requires healing. The advantage of the external fixator is that it holds the bones rigidly immobilized and allows your surgeon to monitor the soft tissue healing.

Once the soft tissues will allow definitive treatment, there are several options available in the treatment of tibial plafond fractures.

Zelle BA, Dang KH, Ornell SS. High-energy tibial pilon fractures: an instructional review. Int Orthop. 2019;43(8):1939-1950. doi:10.1007/s00264-019-04344-8

American Academy of Orthopaedic Surgeons. Pilon fractures of the ankle.

Ho B, Ketz J. Primary arthrodesis for tibial pilon fractures. Foot Ankle Clin. 2017;22(1):147-161. doi:10.1016/j.fcl.2016.09.010

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