Fractures and dislocations: pilon fracture staging: practice question

A Orthopaedics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Orthopaedics · Fractures and dislocations: pilon fracture staging

Sample item

A man falls from a ladder and lands on his heels. The ankle is grossly swollen with blisters, and CT shows a comminuted fracture of the distal tibial articular surface. What is the usual sequence of treatment?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Spanning external fixator first, definitive plating after the soft tissues recover

A pilon (plafond) fracture is caused by axial loading, and the soft tissue envelope over the distal tibia is thin and easily compromised. Early extensive surgery through swollen, blistered skin risks wound breakdown and infection, so a staged approach is preferred, with temporary spanning external fixation and definitive fixation once the swelling settles.

Option by option

  • A. Spanning external fixator first, definitive plating after the soft tissues recover (correct)

    Correct. Staging protects the swollen soft tissues and still allows later anatomical reduction of the joint surface.

  • B. Primary ankle fusion on the day of injury

    Fusion is a salvage option for post-traumatic arthritis later, not an initial treatment.

  • C. Closed reduction and a below-knee cast until union

    A comminuted articular fracture cannot be held reduced in a cast, and the joint surface would heal incongruent.

  • D. Immediate open reduction and plating through a medial incision

    Early extensive incisions through swollen, blistered skin carry a high risk of wound necrosis and deep infection.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is A, Spanning external fixator first, definitive plating after the soft tissues recover. A pilon (plafond) fracture is caused by axial loading, and the soft tissue envelope over the distal tibia is thin and easily compromised.

Why is "Primary ankle fusion on the day of injury" not the answer?

Fusion is a salvage option for post-traumatic arthritis later, not an initial treatment.

Why is "Closed reduction and a below-knee cast until union" not the answer?

A comminuted articular fracture cannot be held reduced in a cast, and the joint surface would heal incongruent.

Why is "Immediate open reduction and plating through a medial incision" not the answer?

Early extensive incisions through swollen, blistered skin carry a high risk of wound necrosis and deep infection.

What concept does this question test?

It tests Fractures and dislocations: pilon fracture staging in Orthopaedics. Early extensive surgery through swollen, blistered skin risks wound breakdown and infection, so a staged approach is preferred, with temporary spanning external fixation and definitive fixation once the swelling settles.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Fractures and dislocations: pilon fracture staging?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.