Fracture Care · Knee, leg & ankle
Distal tibia & pilon fracture
Distal Tibia and Pilon Fractures (Shin Bone Fracture at the Ankle) — Open Reduction and Internal Fixation (ORIF)
The condition
The lower end of the tibia (shin bone) forms the roof of the ankle joint. A distal tibia fracture breaks the bone just above the ankle; a pilon fracture also breaks into the joint surface, often from a fall from height or a car crash. These injuries cause major swelling and pain, and the skin is fragile.
The surgery
Because swelling can be severe, surgery is often staged: a temporary external frame first, then final fixation once the skin is ready (often 1–3 weeks later). Through one or more incisions, the joint surface and bone are lined up and held with plates and screws; the fibula may also be fixed. The final plan is determined during surgery.
Recovery at a glance
- Splint & boot
- Splint and strict elevation for 2 weeks for swelling and wound healing, then a boot; ankle motion out of the boot begins then.
- Weight-bearing
- Touch-down weight (foot flat, ~20 lb) with crutches for 6 weeks—often 10–12 weeks for pilon fractures—then ~25% more each week after x-rays.
- Daily life
- Desk work often within 2–3 weeks if you can keep the leg elevated. No driving while taking narcotic pain medication.
- Activity
- Full release typically 4–6 months. Running between 4 and 6 months once healed; after pilon fractures, impact activities may stay limited.
A general guide. Your restrictions and timeline may change based on what is found and done at surgery.
Risks & benefits
Benefits: Restoring the joint surface and alignment gives the best chance of a stable ankle you can walk on. Risks are uncommon and include infection, blood clots, wound-healing problems (more common with this injury), the bone healing slowly or not at all, ankle stiffness, ankle arthritis over time (common after pilon fractures), injury to nearby structures (such as nerves, blood vessels, or cartilage), stiffness, persistent pain, and the need for further surgery. These will be reviewed with you in detail before surgery.
Patient Surgical Information
Open, save or print. Bring your questions to your pre-op visit.
Before & after every surgery