Well… my surgeon walked in the room after I got out of x-ray and didn’t look very excited to see me. Her first words were “you’ve lost the joint space, the cartilage is gone. With pilon fractures, there can be total cartilage death after 6 months. This is very typical.” She went on to say that the impact of the initial injury (the talus bone ramming upward and shattering the plafond of the tibia, ripping the cartilage to pieces in the process) leads to cartilage death many months after. In some cases (those luckier than me) the cartilage survives enough t allow pain-free walking and much normal use of the ankle.
I almost cried. While I knew that the likelihood of pilon fracture-related cartilage loss and joint collapse was very high, I was very hopeful that I was going to be one of the luckier patients and get a few years of fun in before I had to deal with arthritis, more surgery, etc.
I tried to convince her that I had some good results from PT, and massage, but she ignored me and said it was time I find a ankle specialist who was skilled in post-pilon fracture treatments, and explore my options. She said my lack of dorsiflexion was from the bone at the front of the tibia hitting the talus, and that wasn’t going to stop happening through more physical therapy. She said ankle fusion or ankle replacement were her assumptions of my next procedure but that it wold not be her that did the surgery (Dr Herzog is a orthopedic trauma surgeon and the person who fixed me up when I came into the ER on March 6th.) (She is also very awesome)
So with this horrible news on my mind I drove home contemplating more surgery and no good thoughts. I have been studying up on ankle fusion and replacement, assuming that was where I’d eventually end up, and the downsides of those solutions had me very sad indeed. While they fix the pain of walking, they are by no means the return to normalcy. I still remember the first time I learned what a pilon fracture really was…and that it spelled the end of running, and in many cases, walking for those of us unfortunate enough to receive this injury.
I see the surgeons this week and I am seeking more specialists to talk to before I take the plunge into more surgery. I am hopeful that I find some good news.
Not to be a total downer, here is a story about things I CAN DO while hobbling around on this ankle.. https://www.strava.com/activities/413271549/embed/ddf196e6cd9d52343e4c9b9651d9dd63ba126def” target=”_blank”>Click here for a glimpse of the possibilities for those of us with a bad ankle.
My Pilon fracture can’t stop the bike riding. My ankle feels pretty good with a brace and tape. Glad for what I can do.
Sunsets are just as pretty post pilon fracture, In fact…I’m glad to be alive
Pilon Fractures Suck! 
I’m one month out of pilon fracture surgery myself and just discovered your blog. I’m also an avid cyclist (my injury happened in cyclocross training), so happy at least to see you’re cycling OK. Just requested to follow you on Strava.
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Wow I hope that your impact was light and you have good cartilage survival. Watch out at the six-month point for the change. That is what I’ve learned. Six months after cartilage is injured you get to see what is going to stay and what is going to dissolve.
Did they put a lot of hardware in there? How long was your surgery? Mine was 12 hours. I believe that’s on the long side, they thought it was going to be four or five hour surgery but there was a lot of little pieces when they got to working on me. I remember I was one month in bed afterwards or at least keeping my foot above my heart, and so I had all the time I wanted to watch YouTube and play guitar and goof off on Facebook. I think this injury is worse babying and coming back onto full weight-bearing as slowly as possible and lots of physical therapy. I don’t believe there was any benefit in pushing my progress.
I joined a CrossFit gym and used my knee scooter to get around and they had me do a lot of upper body and core work to stay fit and it really helped pass the time.
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I got 2 plates (one each tib/fib), 14 screws, 3 incisions and I think it took them about 3 hours. Saw my surgeon today, about 5 weeks post-surgery and he likes the way the bones are healing. Says too early to tell on cartilage, but my injury was mostly above the ankle joint so he doesn’t think I’ll be as bad off as some pilon fractures that “explode” the ankle joint.
I’ll be non-weight bearing for at least another month he thinks, but I start basic PT next week. Surgeon also thinks I ought to be able to begin light pedaling (I’m not going to call it cycling at that point) when I start weight-bearing – so I’m looking forward to that for both mind and body. I’ll start that on the indoor trainer at first when the time comes.
Trying to get my hands on a knee scooter now and hoping (is this insane?) that it will eventually allow me to do what had been a twice daily 10-15 minute walking portion of my commute in New York City.
Over time have you been able to stand on the pedals more and more? I can’t believe how quickly my muscles vanished. I was riding 7-10 hours a week (5-6 days) before and hope I can get back to that eventually.
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I am 14 weeks post surgery that resulted in 2 plates and 18 screws. Today I became 100% weight bearing. However I am supposed to stay in the boot. Unfortunately, the boot keeps my foot in one place and because of the difference between a normal left shoe and a right boot it hurts my back incredibly to walk much distance. The swelling is still very pronounced, and I am still am icing. Some days I have pain and some I don’t. I have no idea what to expect as time goes on.
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Hi renee my names natalie & Im also at the 14 week mark on my pilon fracture. I received 3 plates and 20 screws. I am having problems with circulation…. Any who my question ro you is when did the swelling stop & how are you today ?
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Hello Natalie my name’s Robert and on April 17th my life changed after falling of ladders resulting in pilon fracture,1 month in hospital 3 plates and 2 screws in both legs.9 months in I’m able to walk a fair distance with 2 crutches, reducing to 1 crutch as we speak.swelling has gone down,both ankles look like they should.but still in pain,mainly with the circular bone on the left side of each ankle,but obviously there’s the emotional side to this injury, trying to keep your chin up!! ….will get there
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Was hit by a car 2 days ago and have fractured lower tibia in two places and lower fibula in three places. Not sure it constitutes a pilon fracture but orthopedic dr. says that surgery is needed because of the risk of mis alignment followed by arthritis and chronic pain. Waighing the pros and cons of operating while waiting for the swelling to go down.
Any advise?
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If you don’t get cartilage loss will be pacific, you must be proactive to have a good prognosis, good luck…
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What do you mean proactive? when this happens I feel we are in a tunnel in a foreign country and learning as we go…. did anyone have infection due to break going through skin? if so what degree and how did that effect you?
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I’m dealing with both legs right now. I’m freaking out about these fat ugly ankles. I am so bummed.
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I’m dealing with both legs right now. I’m freaking out about these fat ugly ankles. I am so bummed. My ladder broke while I was taking down my life size gingerbread house….grrrrr
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Fell off a ladder March 9 2020. Pilon fracture with bones thru the side of my ankle. Luckily my daughter works for a group of orthopedic doctors. I feel I’m getting too shelf care. Out of the cast a week today. Ankle is still swollen but I am able to move it around some. No weight on it till end of June. It sucks. Today is 4/16/20. Good luck to all dealing with this. Eric
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Almost two years post surgery. Recently my leg and ankle started swelling and I have a lot of pain in my shin. Anyone else had any issues like this? Thanks
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Mine happens march 9th 2020. So far I am doing well compared to most. According to my doc and several others I have talked to.
They say it’s because I am staying very active.
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