Have you recently experienced a tibial plafond fracture or are you someone who just wants to understand the rehabilitation and treatment of a broken ankle at this location.
I am addressing the most frequently asked questions from online users about this kind of fracture, based on
⚫ My knowledge as a diagnostic radiographer
⚫My research in medical scientific studies all references at the end of this article.
The aim of this blog post is to give you some assurance about the progression of your fracture.
Happy reading!😀
Any questions? remarks? Let’s meet in the comments section at the end of this article.🙏
Last updated: Jan 2025. Written by Juliet Semakula, a diagnostic.
▶️What is a tibial plafond (Pilon) fracture of the ankle?
A plafond or Pilon is a type of break of the shinbone (tibia) that happens at the distal end of the tibia.
Most of the time it includes breaks in both the tibia and fibula and at the ankle joint around the inner and outer malleolus.
The tibial plafond articulates with a bone in the foot, the talus to form the ankle joint.
This type of fracture is mainly caused by a high energy impact such as accidents and falls that’s why it usually causes additional injuries. It is very rare in children.
▶️What does a tibial plafond fracture look like? And how are they diagnosed?
Approximately 20% Pilon fractures I have seen are open fractures, meaning the broken bone has pierced through the skin which can lead to infection if not attended to early.
This kind of fracture can break on its own or simultaneously with other parts of the tibia, fibula and foot.
⚫When your doctor says you have a trimalleolar fracture, it means both malleoli are broken in addition to the tibial plafond.
⚫And a complex ankle fracture occurs when the tibial plafond, both malleoli and the fibula are broken.
When you go to the emergency department, you will be assessed and after stabilising the fracture, you will have x-rays to examine the intensity of the fracture.
You will also have a CT or MRI scan to assess other soft tissue injuries and plan treatment management.
These kinds of fractures can be open with or without displacement. The gap between the broken bone fragments varies, closed or non-displaced tibial plafond fractures generally recover faster.
Mair, 2021
A Preoperative X-rays and CT scan showing the fracture fragments for a Pilon: image from Wu,2020
▶️What is the treatment for a tibial plafond fracture?
When you have had a Pilon fracture just know that it can be sometimes challenging to treat because they involve the ankle joint.
Reason being it usually damages the surrounding soft tissues such as muscles, skin and ligaments.
So, treatment for a Pilon fracture will depend on several factors
♦The number of fractures.
♦The pattern and type of the fracture.
♦If the bones are displaced or (not aligned) and how much they are displaced.
♦Examine the surrounding tissues, muscles, tendons and ligaments.
Most of the time treatment for Pilon fractures is surgical but if your fracture is not displaced and the bones are well aligned properly you may not need surgery.
Non-surgical treatment (very rarer): what is it?
In some patients especially the elderly surgery may sometimes not be safely performed in such cases: The fracture is reduced without surgery.
🟢Your leg will be put in a cast, splint or boot to help stabilisation of your ankle.
🟢 You may use a walking aid such as crutches in the first weeks not to put any pressure on the affected leg.
🟢You will be given medication to help with pain and any infection.
🟢You will be told to rest and elevate the affected leg to reduce pressure and ease swelling.
🟢You will be recommended not to put weight on the fractured leg while walking for 6 to 10 weeks.
🟢You may need physical therapy to help you restore strength in your ankle.
Surgical management:
Usually if you have other injuries your surgery may be delayed until the swelling goes and you are healthy enough to minimise any risks such as infection.
I have witnessed two common types of Pilon fracture surgery being done.
1️⃣The open reduction internal fixation (ORIF)
This kind of surgery, the surgeon will open the fracture sight and the displaced bone fragments are first repositioned into their normal alignment.
The fragments are then held together with screws or metal plates that are attached to the outer surface of the bone.
Open reduction and internal fixation
Postoperative AP and lateral X-ray: image from Wu,2020
2️⃣External fixation.
The surgeon makes small incisions (cuts) into your skin and inserts metal pins through your bones. The pins stick out of your skin and are attached to bars outside of your body.
The external fixator acts as a frame to help hold your ankle in a stable and secure position until your surgeon can perform a second surgery (usually open reduction and internal fixation) to fix your fracture.
For example, If the fracture is open, like in the image below, skin flaps from another location can be used to cover the injured area. This is done simultaneously with the operation to reduce and stabilize the fracture or later.
X-ray image of Anteroposterior, immediate debridement, spanning external fixation. Image Chen 2022
▶️What does the rehabilitation of a tibial plafond fracture involve?
Regardless of which treatment is used for your fracture, just know that these kinds of injuries are severe and lead to long-term dysfunction and recovery.
Here in the UK, you will be given a follow up appointment to a fracture clinic and an adaptation care plan after surgery.
After assessment you may be prescribed physiotherapy sessions after a follow up x-ray, when more movement is possible.
You will return home after a few days after the operation but if you feel you’d like to see someone at any time in the six months after your injury, you can always book an open appointment to see the doctor.
Caution! Your consultant may give you a different, personalised care plan based on your injury.
▶️Rehabilitation during the consolidation phase
The main goal of rehabilitation is to get you back on your feet and prevent too much loss of muscle and functional capabilities.
But the truth is, there is no rehabilitation technique or medication that can accelerate a quick healing.
During the consolidation phase you will be given follow up appointments to assess the quality of consolidation, bone union and the systematic axis.
To avoid ankle and knee stiffness you must try to remain as active as possible without necessarily attempting specific exercises.
The other goal of rehabilitation is to alleviate painful symptoms and potential swelling associated with the fracture by giving you different advice such as rest and elevate the affected leg.
▶️Rehabilitation once healed.
The second phase of rehabilitation begins when consideration is achieved. You will have an assessment after 6 to 10 weeks.
X-ray will be taken to assess bone union and healing whether you had an operation or not.
Your doctor will assess your pain levels, the main goal of this phase is to see if you are regaining a perfect functionality and mobility.
In some cases, the hardware is kept for life if it does not cause any issues or it can be removed in the months or years following. Once the consolidation is well established like in the image below.
X-ray images of a 6 months postoperatively, as well as after implant removal: image from Wu et al 2020
Rehabilitation will begin with a gradual re-introduction of weight bearing on the affected leg. You will need observation and assistance with family or physiotherapy.
The tolerated weight on the ankle will be based on the pain indicator at that time, you can increase day by day or week by week.
You will need to use two crutches in the beginning and finally with a single crutch before you decide to withdraw.
You will be able to walk without crutches after 1 to 2 months after a tibial plafond fracture and later at 3 to 4 months.
▶️Is it normal to experience pain after a tibial plafond fracture treatment.
Whether you have undergone surgery or had only a cast, it is common to experience pain even when you are following your doctor’s instructions such as taking painkillers.
After surgery you will feel some pain in the first days which is a natural process of healing. The intensity of the pain does not necessarily relate to the severity of the fracture.
Pain will persist for several weeks even at rest, without putting weight on the affected leg. Remember pains are often a result from inflammation, a beneficial defence reaction of our body.
You should not worry especially if it’s not affecting your sleep or daily activities. But you can always seek advice from your doctor.
You will be given some instructions after your surgery to help with your pain at home.
Here are some of the recovery tips to help you.
♦Pain medication
♦Rest the leg, do not put weight on for the first weeks to allow healing.
♦Limit smoking or stop smoking
♦Try to eat healthy and keep exercising when pain allows.
▶️ Why does the ankle swell after a Pilon fracture?
Ankle swelling after a Pilon fracture is a normal reaction of the body which is related to inflammation like pain.
The swelling will last for at least several weeks and often several months. Some people complain of swelling several years after a tibial plafond fracture.
Most people worry when swelling is not going away however if it is not associated with pain and discomfort in performing your daily activities, there is nothing specifically that can be done.
Your doctor will advise you to wear compression socks to help limit the swelling.
▶️What is the healing and recovery time for a tibial plafond fracture?
Healing time and complete recovery of the tibial plafond fracture is usually different for everyone.
But it normally takes at least 2 months for the healing to be well consolidated.
After a follow up x-ray, your doctor will be able to tell you whether your fracture is healing well or what is appropriate to do at this stage.
▶️Walking after a Pilon fracture, when is it possible?
Most patients I have seen with Pilon fractures after surgery are not allowed to put weight on the affected leg for at least 2 to 6 weeks.
But this will again depend on the type and how severe the fracture was and the treatment you receive.
It is possible to resume walking in the first few days after your hospitalisation visit, but of course you must adapt the way of walking.
For example:
If you have an external fixator, you may not be able to start moving your ankle until the external fixator is removed.
Because your leg and ankle will be immobilized for a period, you will be at greater risk for developing blood clots.
🟢Most patients are not able to put all their weight on their injured ankle for 2 to 3 months.
Once you are allowed to move the injured leg, it will be placed in a removable cast or brace so that you can begin physical therapy.
When you are given a go ahead to gradually start putting weight on the leg, you will first use crutches to help you not to put full pressure of a maximum of 10/15 kg on the leg.
🟢With partial or total support on the fractured leg, this will depend on the pain.
🟢Exercises to strengthen the supporting muscles will be added around 6 weeks after surgery.
By 4 months after surgery, most patients no longer need a walking aid. It is important to continue the exercises even after you have completed the formal physical therapy program.
▶️What are the possible complications of a tibial plafond fracture?
In the early 1990s, the complication rate after a tibial plafond fracture was very high but this has changed over the years.
Here are some of the possible complications after tibial plafond fracture.
🔵Post-traumatic arthritis which is caused by ankle fusion in adjacent joints, especially when the subtalar joint and the foot are involved.
🔵Ankle stiffness due to the extension of the external fixator into the foot, which improved with satisfactory results after 4 months of physical therapy
🔵 Early open reduction and internal fixation (ORIF) have been reported to be associated with severe soft tissue complications and deep wound infection for open Pilon fractures
🔵Decreased mobility.
🔵 Infection usually in the early days or weeks after treatment or delayed union.
🔵The need for additional surgery
🔵 Residual pain
Chen et al 2022
▶️What is the healing time after a tibial plafond fracture?
The length of time it takes for a Pilon fracture to heal will depend on the severity of the injury and if you had other injuries from the event that caused the Pilon fracture.
We do not have studies that precisely follow the healing and recovery time of different individuals after a tibial fracture.
I consulted one of the Ortho doctors at my hospital who gave me an audit of some of the patients seen at the trust.
| Stages | Typical time frame |
| Reducing swelling | Several weeks |
| Bone consolidation | 6-10 weeks or more |
| Resumption of walking with weight-bearing | Sometimes immediately, sometimes weeks or months depending on surgery type and your health. |
| Walking with crutches | Immediately but if you had external fixation, you will not be able to walk straight away. |
| Non bearing weight or with assessed support | Immediately depending on how you feel |
| Return to work | 2 months or it will depend how well you are recovering; you can discuss this with your doctor. |
| Return to sports | 3-12 months, you must avoid impact sports, jumping, running, dancing, and heavy lifting for at least 12 weeks. |
| Full function and muscular recovery | 6 months after surgery, some people can take 1 year or more to recover. |
| Complete healing of the fracture | 6 months after surgery, some people can take 1 year or more to recover. |
Healing timeline after a tibial plafond fracture.
We have come to the end of this article; hope I have answered some of the common questions about Pilon fractures.
Wishing a quick recovery.🙋
You may also like:
🔵Understanding tibia fractures
🔵 Why do broken bones hurt more at night?
📚Source:
Harwin SF, Taylor BC, So E, Karim A. Spanning External Fixation for Pilon Fractures: Steering Wheel and Kickstands. Orthopedics. 2020;43(3):e187-e190. doi:10.3928/01477447-20200129-06
Chen, Y., Li, Y., Ouyang, X. et al. Ankle joint salvage and reconstruction by limited ORIF combined with an Ilizarov external fixator for complex open tibial pilon fractures (AO 43-C3.3) with segmental bone defects. BMC Musculoskelet Disord 23, 97 (2022). https://doi.org/10.1186/s12891-022-05060-
Wu, D., Peng, C., Ren, G. et al. Novel anterior curved incision combined with MIPO for Pilon fracture treatment. BMC Musculoskelet Disord 21, 176 (2020). https://doi.org/10.1186/s12891-020-03207-3
Kellam PJ, Cutshall ZA, Dekeyser GJ, Rothberg DL, Higgins TF, Haller JM, Marchand LS. Recovery Curve for Patients with Pilon Fractures Using Patient-Reported Outcome Measurement Information System. Foot Ankle Int. 2023 Apr;44(4):317-321. doi: 10.1177/10711007231156424. Epub 2023 Mar 17. PMID: 36932665.
Mair O, Pflüger P, Hoffeld K, Braun KF, Kirchhoff C, Biberthaler P, Crönlein M. Management of Pilon Fractures-Current Concepts. Front Surg. 2021 Dec 23;8:764232. doi: 10.3389/fsurg.2021.764232. PMID: 35004835; PMCID: PMC8732374.