Research on the Morphology and Injury Mechanism of Pilon Fractures

This study investigates the link between injury mechanisms and the morphology of high-energy Pilon fractures to support accurate clinical diagnosis and treatment. It includes 192 patients from Lianyungang Second People's Hospital (2010–2024), categorized into five groups based on trauma history and imaging: dorsiflexion, varus, valgus, plantarflexion, and neutral. Two experienced orthopedic surgeons independently assessed X-rays, CT scans, and 3D reconstructions, noting fibular fracture details, tibial fragment distribution, fracture angle, and Topliss classification. Statistical analysis was done using SPSS 25.0, with chi-square or Fisher's exact tests (P < 0.05 for significance). The study identified distinct fracture patterns based on injury mechanisms (P < 0.05): Dorsiflexion injuries often had "medial + anterolateral + Die-punch" fragments (45%), fracture angles > 90° (65%), and coronal Y-type fractures (25%). Varus injuries typically presented "anterolateral + posterolateral + medial + Die-punch" fragments (32.5%) and sagittal split fractures (40%). Valgus injuries were associated with comminuted fibular fractures (64.3%) and tibial coronal V/Y-type fractures (35.7%). Plantarflexion injuries frequently involved posterolateral fragments (61.5%) and fracture angles > 90° (80.8%). Neutral injuries were marked by complex comminuted fractures, with 33.7% showing Die-punch collapse. This study establishes a significant correlation between the morphology of high-energy Pilon fractures and their injury mechanisms, suggesting that preoperative mechanism classification can enhance surgical strategies and minimize complications.