Abstract
April 29, 2005
Dear Editor,
I read with interest the article by Michelson, Moskovitz and Labropoulos titled: The Nomenclature for Intra-articular Vertical Impact Fractures of the Tibial Plafond: Pilon versus Pylon. While I agree with most of the authors' observations, I suggest an alternative conclusion which is to use neither “pilon” nor “pylon” bur rather “plafond.”
As the authors of this article suggest, “pylon,” an English word, has almost nothing to do with the distal tibia. As also suggested in the article, “pilon” is NOT an English word but has been used by various French and Swiss authors in English language articles. Its use has taken on much of the imprecision of an eponym with some suggesting that it describes the mechanism of injury while others use it to refer to the anatomic region and others combine both concepts. Some would consider extra-articular distal tibial fractures from axial load to be “pilon” fractures, whereas others would not.
I suspect the use of “pylon” may have partly been the result of computer spellcheckers and publishers using standard English spelling of words, a laudable practice. Rather than solving the problem this created more confusion.
There are primarily two types of intra-articular distal tibial fractures, namely malleolar fractures and plafond fractures. These are fundamentally different injuries with vastly different frequencies, mechanisms, treatments, complications, and outcomes. Plafond is an English word commonly used in the orthopaedic literature and appears in Websters and the Oxford English Dictionaries, derived from the French for a ceiling formed by the floor of the story above. It seems a good term for the ceiling of the ankle joint formed by the distal end of the tibia. Even Michelson et al. use “plafond” in the title of their article.
The Orthopaedic Trauma Association Comprehensive Classifications of Fractures and most other good fracture classification systems in current use are based on anatomic location of the fracture, and there are two categories of distal tibial fractures. Malleolar fractures are designated 44 while plafond fractures are 43. Extra-articular distal tibial fractures are 43A while partial articular (43B) and total articular (43C) involve the articular surface. There are no separate classifications based on mechanism of injury such as “twisting” or “axial load.” Mechanism of injury is simply described in words rather than being the basis of a classification system.
Therefore, regarding nomenclature for fractures of the distal tibia, I suggest that the orthopaedic literature in English use the anatomic terms “malleolar” and “plafond” and relegate both “pilon” and “pylon” to the historical repository with many other eponyms. Mechanism of injury can be described separately, as with other fractures.