Pilon fracture + broken tibia

Hi all,

Over Thanksgiving I sustained a tibia fracture + ankle pilon fracture to my right leg during an unfortunate lead fall in Red River Gorge. My tibia was stabilized with an IM rod and my ankle with 2 screws in early December. I am scheduled to start partial weight bearing this week and they expect me to be out of the boot by end of February - walking normally in March - back to hiking this summer and skiing next season. So, overall the prognosis is good considering the seriousness of the injury. 

I know every person has vastly different results depending on their overall fitness, severity of injury, and luck. However, I'm curious to hear of other climbers' experiences with one or both of the above fractures and how it impacted getting back into climbing (mentally + physically). I know arthritis is a possibility with pilons and would be curious if anyone has developed significant arthritis in the years after their pilon fracture.

Any stories (especially positive ones!) or advice would be welcome. Thank you!

Me.  1985.  Bouldering slip and fell ten feet.  3 screws.  

It will take months to heal and will be tender for much longer. Definitely do maximum physical therapy.  Mine was limited and I never got the range of motion back.  Pull the screws as soon as they let you. It's another operation but worth it. Doc said, "You can't feel them."  eF him.  It's like having a rock in your shoe and you can't get it out. 

So then you battle the inflammation for years, or you do what took me 30 years to figure out and get processed sugar totally out of your diet.  It is the source of most inflammation including arthritis and much more. Eat healthy and NO sugar, which is trick because it is thick in everything.

Mentally, how much do you need to climb?  For me, I NEED to climb.  Was a little flinchy at first but it goes away as you rebuild confidence. Since then I have climbed much, mountains, backpacked, skied and hiked many miles.  The stiff ankle is always there.  I ignore it.  If it hurts I ignore it.  Does slow me down a bit.  I wish I had been more careful.  I don't run unless someone is after me.

Thanks, Spider Savage! I really appreciate your response. 

I start PT this week and definitely plan to go to town on it - continuing way past my prescribed sessions run out. My doc did mention I might feel the ankle screws eventually so I anticipate removing them at some point. I'm hoping that's not the case with the tibia rod, though, as that's a much bigger operation.

Good heads up on the processed sugar too. I've been very anal about my diet for years and I've cut out probably 98% of processed sugar already. So it wouldn't be difficult to cut it out completely.

I think all of us who injure ourselves wish we were more careful. But, accidents certainly happen and it's good to know your injury didn't keep you from doing the activities you love. 

Thanks again for your reply!

Hey, I went through a similar break last September. I'm now 4 months out and back to climbing! I still have some pain in my knee and leg due to compensatory injuries (not from my initial accident), but it has not been completely limiting. 

I worked really hard to keep my upper body strength while I was recovering, and I even think I got a little bit stronger. Last week I was able to send one of my projects from before my injury:)

The mental strength comes back with time and it's a different process for everyone. Be patient with yourself and give it some time. When you first come back, try sticking with routes that you are familiar with and know you can do. 

I also recommend working closely with your PT. Your surgeon will be the one to clear you for certain activities, but your PT will be able to give you better guidance about exactly how to go about doing those things again. For me at least, it was hard not to rush back into climbing and everything, but it's really important to take your time. 

Best of luck! Hope everything goes well with your recovery!

Hi Molly! Thank you so much for the inspiring reply - what great news! I'm really glad to hear you're back to climbing so soon. Did you suffer a pilon fracture + tibia fracture? Or just the tibia?

I was pretty hopeless when I wrote my post but a few days after that I started PT and that's been revolutionary. The difference in 3 weeks in insane. I've been doing PT exercises 3 hours a day (4 hours if I include my upper body workout) and am grateful to have little to no ankle pain. I will be cleared to be full weight bearing next week. I can't believe how quickly my ankle is responding - my ROM improves by the day. I am now optimistic that I can at least be back to my 'on my feet' job by March. I have been pre-warned about overcompensation injuries from a friend of mine who tore her ACL. So I'm definitely going to try to slowly scale back into climbing. I anticipate many many hours at the gym in my future working on building leg muscle before I get back on the end of a rope or hike a trail.

The only complication I've had so far are my dissolvable stitches. Now that my body isn't so fully focused on bone healing it's are attacking the stitches under my knee. So I have a swollen bump which makes knee bending uncomfortable. My ortho said they will take time to dissolve and then it will go away but in the meantime it is annoying. Wondering if you had anything like that with your surgery?

Yeah, I did have a pilon fracture as well (comminuted spiral tibial fractures that extend to my ankle joint). I didn't have dissolvable sutures so mine were taken out 7 days later and then I had to use steri-strips for another week. I have a little bit of numbness at the incision by my ankle, but otherwise the incisions have healed well.

All of our gyms are closed here so i went straight back to climbing outside. I did clear it with my surgeon and PT first, but I think it would have been easier to start in the gym.

That's great you are so diligent with your PT. I also feel like the upper body/core workouts help with the healing because they get your blood flowing. I know my leg always felt better after I did some upper body work.

It sounds like you are making really good progress too :) 

I'm going to try some acupuncture as well. My friend said it helped a lot with her injury.

Wow - that's so encouraging that you're back at it with such a similar injury. Awesome! Acupuncture is a great reco too. Thanks again for your positive response!

You are having a great recovery. I had a pilon fracture (type 2) December 27th and am still in the early recovery - non weight bearing for another 3 weeks. Since I've got access, I've really dove deep into the literature about pilon fractures. Type 1 and 2 pilon fractures seem to heal well, once you get to type 3 and worse the outcomes are pretty depressing. It also sounds like you were able to get away with only an anterior incision, which has much better outcomes. I had a posterior incision next to my Achille's - the scar formation and limited range of motion is much worse with posterior incisions. I'm at about 3 degrees of dorsiflexion right now, need to get to 10+ for a normal gait. I'm hoping once I get full weight bearing I'll get more rapid gains like you.

Overall I imagine active people like climbers get much better recovery than the average population. That's what I'm hoping! I probably won't be running again since the impact on the joint has too high a risk of exacerbating early arthritis, but there are plenty of other ways to keep the lungs pumping.

Always reassuring to hear about good outcomes from people with a similar injury.

Hey AC,

Thanks so much for the message! Bummed to hear about your fracture but sounds like yours is on the better side of things too. That's great news about Types I and II. I didn't get the exact type from my ortho but will have to ask. Given that I only had 2 screws and a small incision I imagine it's no more than II as well.

Sounds like we're on the same time frame for recovery. I started 25% WB 6 weeks after surgery. I just graduated to 100% WB last week and added on a few tougher exercises. It's been a pretty painless transition though my ankle is finally feeling some soreness this week.

I will definitely say that starting PT allowed for rapid gains very quickly and I'm sure you'll experience the same. Each week I'm adding 2 - 3 more degrees to dorsi + plantar flexion. It's really amazing how quickly you improve once you start PT. It also helps tremendously with your mood. A few weeks before I was able to start PT I was definitely at my lowest but once I started PT I felt so much better. And forget it, once you're down to one crutch and can carry a glass of water again it's like you won the lottery!

And as you said, if you're going to have an injury it's best to be healthy and active first. That will definitely result in better healing outcomes and I bet you'll be well on your way back to climbing in no time. 

Luckily I'm not a runner (gave that up to save my knees for skiing) but I love long hikes and my ortho seemed to think that'd be no problem in the future. Arthritis is a concern but my ortho said it's often hard to predict if/when that happens since every case is so different.

Definitely send an update once you start weight bearing and let me know how it's going! We're only a month behind each other in injury timing and I'd love to hear how you're progressing and would be happy to continue sharing my PT experience as I go. :)

I started working into weight bearing two weeks ago and progress has been great! My surgeon is old school so wanted no weight bearing for 10 weeks. Once I hit that mark I graduated to two crutches for a week and have now been doing one crutch for a week. I think next week I'll be walking. My dorsiflexion is improving, I'm at about 10 degrees after some active stretching, but it all depends on the day. I've been getting some swelling since starting to put weight on the foot but pain has been pretty limited. In fact, I have been surprised how little pain I have had, even right after the fall. The first week after surgery was rough but has otherwise been easily tolerated. The sorest thing for me right now is my upper calf as I rebuild the muscle. Now I understand why astronauts can't walk when they first get back to earth!

I got some compression socks through amazon, and find that really helps keep the swelling down throughout the day. Ice baths are also great. I got a decent coleman cooler to keep the ice and water in and it keeps it cold for 4-5 days rather than having to throw out the water and start fresh every bath. 

I hope we keep  moving in the right direction!

AC - that's awesome! Thank you so much for the update. You are totally on target for 100% recovery.

It sounds like your ankle is progressing exactly like mine at that time. As of now, I've been fully weight bearing for 5 weeks - out of my boot for 3 weeks. You can barely tell the difference between my ankles at this point. I have swelling when I leave it down for an exorbitant amount of time (like the straight 15 hour drive I did last week). But otherwise it's pretty damn good. My dorsiflexion is now matching my good ankle and I've moved into some light agility in PT. I'm back at the gym doing leg training (leg press, squats, etc) and stretching that pesky soleus muscle. Give that some time - mine is only just now feeling looser (took a whole month of daily stretching to get it to stop being so painfully tight).

I have also had almost no pain throughout recovery. I did have some additional soreness when I went full weight bearing - especially without the boot. If you have that don't sweat it - it's just your muscles or irritated tendons getting back to work. As my muscles have been getting stronger that soreness has been disappearing.

Each week is a big improvement. The stiffness I was feeling daily even just a few weeks ago has drastically reduced. It's so amazing how quickly you go back to normal after weight bearing + PT. You'll be crushing it again in no time. So glad to hear how well things are going. Keep up the good work!

I dunno if you're doing this but I bought a bike trainer stand for my bike and rode that 2x a day since I was allowed to. I swear that's helped tremendously with ankle mobility and getting my quad back to basically normal size in no time. I'd highly recommend getting one of those if you don't have one at home.

I'm now a little over 6 months out from my injury. I started climbing again 14 weeks out and surfing 4 months out. I have been sticking to the gym for now but will start doing some easy outside routes at the end of the month. It's going to be hard to push it and take falls in the same way but maybe I'll get there again. At least now I have an excuse if I use a full rack to get up a 30 foot 5.7.

Early activity was definitely key to my recovery. Every time I added on new activities I got sore for a few days but then noticed dramatic improvements in function. I think the weird loading angles of climbing and surfing really helped break down scar tissue. My dorsiflexion will probably always be a little limited but my gait is normal so not a big deal. I think I'll get the two biggest external screws removed after snowboarding season but the 5 internal screws and small plates are there to stay - too hard to access at this point.

A friend got a pilon fracture dirt biking a few months after mine and her recovery has been much slower, despite it being a less severe fracture and repair. It's a bad break and seems like really variable outcomes.

I hope your recovery is going well Samantha!

Hey AC,

Great to hear about your recovery. Thank you for the update! I'm also doing super well. My dorsiflexion is fully back but my plantar flexion is slightly less than my good ankle. It's not enough to affect any activities, though. I can still child's pose like a boss. :) I started climbing indoors the second I was cleared to do so in April and have TR’ed outside a few times since then. My ortho said I could lead again in a few months but I’ll likely wait for that until next season (or likewise stick to sewing up 5.6)! I agree that climbing is great rehab for the ankle - all that standing on your toes and twisting around has helped to bring my flexibility and calf strength back.

The only real issue I've had is with the area below my knee (where my hamstring attaches). Turns out my right hamstring was not strong when I started hiking again back in April so I've had some tendonitis there. But, now that I know the issue I’ve been really focusing on hamstring exercises and essentially hiked the pain away this past month. It’s totally true – the more you move the better your leg will feel. 

I’m also aiming for ankle screw removal in the fall to heal up just in time for ski season. My tibial rod will be in (hopefully) for life since it does not cause any pain at the moment and is major to remove. 

The best part about a good recovery is the whole incident has stopped being at the forefront of my life. Most of the time I forget I even broke the whole thing. So, I’m really thankful for that (as are my friends + family who were probably done hearing about the progress of my ankle swelling).

Real bummer about your friend’s pilon fracture. It’s true that recovery is variable based on the break and surgeon. Though I do believe the more motivated you are to heal the better the outcome.

Anyhow, super psyched to hear you are doing well. Keep up the good work and hopefully we’ll both be leading again without a care in the world very soon.  

Samantha… great news about healing in a good way!
I have found that after a major injury your not really cured until you crash and burn again without braking something. So go climbing and skiing- put this in the past. Good luck! Do that PT with vengeance. 

Hey Guy! I think you might not have read my other threads. PT is a part time job for me and I'm already back out climbing (unfortunately can't ski in the summer but I am mountain biking).

Hey -- adding to this thread to ask a few questions of others who've had this injury and for anyone in the future who sustains this injury and comes looking for information, I know I scoured every corner of the internet looking for info for the first few weeks. It was great to read this thread early on and hear about all of your all's recoveries! Would love to hear any updates from others who have posted. 

Overview of my journey: Pre-injury i was guiding multi-day hiking/backpacking trips, running 20-40 MPW training for a 60k, and climbing 3-5 days a week, mostly outdoors. I took a lead fall in Joshua Tree on April 1, 2023 and suffered a pilon fracture of my tib/fib. ExFix on 4/3/23 and ORIF on 4/14/23. I was NWB for 6 weeks post op, started partial weight bearing for a few weeks and full weight bearing around 9 weeks post op. Started PT during this time. In July (10 weeks post op) i started hiking with crutches and top roping. In the following months I started top roping a ton, hiking increasing distances, biking, swimming, and lots of strength and PT. I thought for months that I'd need to find a new job but I have returned to guiding easy hiking trips.  The furtherest I have hiked is 7 miles. I even spent 10 days in the creek in Oct, apparently inversion is a lot better for me than dorsi/planterflexion :) However, I have not started leading climbing or running again. My ankle/leg still feels pretty weak, stiff, tender.

Side note: The first surgery was in Joshua Tree at the Hi Desert Medical Center -- if you get injured in JTree i do NOT recommend going there. Just go straight to Palm Springs if you can. 

When I first started to realize the severity of my injury, i felt like my world was crumbling and i searched everywhere to find people (mostly climbers and runners) who'd suffered similar injuries. So if you come across this post in your own desperate search for answers, info, hope, etc, I hope this helps and you can totally message me for more :)

Initially my recovery went very well. I started weight bearing far sooner than anticipated, hiking, guiding and climbing MONTHS before they told me I would. Unfortunately, I have started to experience more pain and less mobility over the last month or so. 

This week (abt 7 months out) I got X-rays and CTs that showed a broken screw, the bone and grafts not growing together, and arthritis already in the tibia/talus joint. The doctor basically told me that my body has done all the healing it will do and the mobility and pain levels i currently have are pretty much here to stay. He said the only option for the arthritis is an ankle fusion, but given my age (24 y/o), we want to push off any surgical interventions as long as possible. I am already aware of other interventions like bracing, diet (i limit sugar, processed foods, inflammatory oils, refined grains, etc), cortisone shots and TAR (though he also doesn't recommend those given my age). 

My question for others who've had pilon fractures is about the arthritis. Has it already set in in your ankle? How do you manage it? 

Impact still causes me a lot of pain, i thought I'd start leading again when that subsided, but Dr makes it sound like thats not going to happen. I've accepted (or im working on accepting) that I wont be a distance runner again, but if you have ankle arthritis, do you lead climb? Take falls? How does that feel? 

Have you found any other treatments that provide relief or allow you to live an active lifestyle with the arthritis? I am cool with pushing through the pain, but if theres anything extra I can do I am game to try!! Even the most granola of treatments, I wanna try. 

Martha Helsley wrote:

Hey -- adding to this thread to ask a few questions of others who've had this injury and for anyone in the future who sustains this injury and comes looking for information, I know I scoured every corner of the internet looking for info for the first few weeks. It was great to read this thread early on and hear about all of your all's recoveries! Would love to hear any updates from others who have posted. 

Overview of my journey: Pre-injury i was guiding multi-day hiking/backpacking trips, running 20-40 MPW training for a 60k, and climbing 3-5 days a week, mostly outdoors. I took a lead fall in Joshua Tree on April 1, 2023 and suffered a pilon fracture of my tib/fib. ExFix on 4/3/23 and ORIF on 4/14/23. I was NWB for 6 weeks post op, started partial weight bearing for a few weeks and full weight bearing around 9 weeks post op. Started PT during this time. In July (10 weeks post op) i started hiking with crutches and top roping. In the following months I started top roping a ton, hiking increasing distances, biking, swimming, and lots of strength and PT. I thought for months that I'd need to find a new job but I have returned to guiding easy hiking trips.  The furtherest I have hiked is 7 miles. I even spent 10 days in the creek in Oct, apparently inversion is a lot better for me than dorsi/planterflexion :) However, I have not started leading climbing or running again. My ankle/leg still feels pretty weak, stiff, tender.

Side note: The first surgery was in Joshua Tree at the Hi Desert Medical Center -- if you get injured in JTree i do NOT recommend going there. Just go straight to Palm Springs if you can. 

When I first started to realize the severity of my injury, i felt like my world was crumbling and i searched everywhere to find people (mostly climbers and runners) who'd suffered similar injuries. So if you come across this post in your own desperate search for answers, info, hope, etc, I hope this helps and you can totally message me for more :)

Initially my recovery went very well. I started weight bearing far sooner than anticipated, hiking, guiding and climbing MONTHS before they told me I would. Unfortunately, I have started to experience more pain and less mobility over the last month or so. 

This week (abt 7 months out) I got X-rays and CTs that showed a broken screw, the bone and grafts not growing together, and arthritis already in the tibia/talus joint. The doctor basically told me that my body has done all the healing it will do and the mobility and pain levels i currently have are pretty much here to stay. He said the only option for the arthritis is an ankle fusion, but given my age (24 y/o), we want to push off any surgical interventions as long as possible. I am already aware of other interventions like bracing, diet (i limit sugar, processed foods, inflammatory oils, refined grains, etc), cortisone shots and TAR (though he also doesn't recommend those given my age). 

My question for others who've had pilon fractures is about the arthritis. Has it already set in in your ankle? How do you manage it? 

Impact still causes me a lot of pain, i thought I'd start leading again when that subsided, but Dr makes it sound like thats not going to happen. I've accepted (or im working on accepting) that I wont be a distance runner again, but if you have ankle arthritis, do you lead climb? Take falls? How does that feel? 

Have you found any other treatments that provide relief or allow you to live an active lifestyle with the arthritis? I am cool with pushing through the pain, but if theres anything extra I can do I am game to try!! Even the most granola of treatments, I wanna try. 

Compound tib fib ankle 30 years ago. I was a runner before and did run again for a couple years but never more than 10 km as it hurt too much. Still have the screws in. Number one advice- when you hike for more than 30 minutes use hiking poles. It takes 20 kg off each step which over the course of a day’s walk is tonnes of less impact on the ankle .

I have been having PRP injections into the ankle and tendons around the ankle that inflamed after 15 years. The tendons definitely improved but the ankle is hard to judge. Celebrex is my friend. Cycling is great. Climbing is fine too as long as I don’t have to extreme high step left. I hear that stem cell treatment is coming along so I might consider in a few years. If you can take out the hardware I recommend you do so - i wish I had and now the screws are irritating the skin 

Hi everyone. I’m 2 weeks shy of 10 years with a Pilon fracture that took 2.5 years & 7 surgeries to heal correctly. Short story is I was hit by a car while cycling & thrown into a ditch. Plenty of injuries but the pilon fracture rose to the top in severity. Currently, there is arthritis in my ankle. ROM has decreased over the decade & some pain, but a lot of stiffness persists. After the 1st surgery I broke 17 of the 24 screws in my leg. My last attempt at saving my lower leg included an external fixator for 6 months. It healed, thank goodness. I had all hardware removed, which I think was and is a good move.  These days, I can still cycle, and tele-ski. Dropping into a turn on my bad ankle hurts and isn’t as deep as on my other side due to lack of ROM. I can hike w/ski poles & shuffle, but not really run. CBD cream helps me get to sleep, but I’m typing this at 1:30am… which means my ankle has me awake. True for most nights. I also had a lot of nerve damage due to the injury itself, but also due to repeated surgeries to fix the injury. That’s the 2nd biggest problem. After 7 surgeries, my bad leg is an inch shorter than my good leg. Another problem. But here’s the thing: the only way is forward. Your body will heal itself. Will you be your old self? No. But work on making that ok. Acceptance helps… which I’m still working on. Good luck & keep posting and talking about your experience. It helps all of us! Cheers, debra

My update 3 years later: I'm back to climbing, surfing, snowboarding, and have picked up mountain biking since I'll never run again. I'm just barely getting my lead head back, and haven't been able to take a big fall yet, but I'm getting there. Most days I have minimal pain but my range of motion is fairly limited, which makes hiking downhill slow and tenuous since I'm afraid of twisting the ankle. Hiking uphill is comparatively much faster. I could probably start running again but it's not worth the joint impact and mountain biking is more fun. Every so often I step a little funny and get a shooting pain but that is becoming less and less common.

I've found a couple things to be helpful. First, for range of motion I stand flat footed and move my knee into the wall until it touches, and I hold there for 3-5 seconds. I move my foot progressively further out until I can no longer touch. I was starting to get pain over my medial malleolus where the screws are and thought I would have to get them removed but restarting stretching made the pain disappear. I also find pulsing Naproxen once a week is really helpful to keep pain levels down. I noticed after a few days of snowboarding my ankle would start to feel better than it had in months and at first I thought it was the shaking and impact breaking up scar tissue. Turns out it's just because I was taking Naproxen when I was snowboarding and the one time I didn't I got pretty sore. When I'm hiking or walking a lot it is useful to wear high sided shoes to give some extra support. 

In the range of recovery I'm very lucky to remain as active as I am. I had just the pilon fracture, although fairly high grade, and didn't break the tibia. I had a meticulous surgeon, was able to get ORIF on the first go, and heal well. Reading the literature I'm definitely on the rare lucky side in that I don't have pain limiting daily activities. From a review: "Complications are high with treatment of pilon fractures, and prognosis is worse than most other orthopedic injuries given high rates of infection, joint stiffness, and tibiotalar arthritis." Pilon fractures are probably more common in the climbing community from the type of impact we take, but at least climbers tend to be fit, have good extraarticular muscle support, and are motivated to do PT and get active again.