Some people are able to run much sooner after breaking their ankle. They often result in an obvious deformity of the ankle joint. A pilon fracture is a type of break of the shinbone (tibia) that happens near the ankle. By this time, the bones in your ankle should be well healed and your ROM and strength should be close to normal. Updated June 17, 2015. It included knowledge about rehabilitation exercises as preparation for doing the exercises, types of exercises that can be done, frequency, precautions that can be taken. Prognosis of physical function following ankle fracture: a systematic review with meta-analysis, Scar tissue tightness (if you have had surgery), The amount of effort you put into your rehabilitation. If you need more information about your particular injury and options to treat it and recover quickly and safely, talk to me one-on-one! By this time, the bones in your ankle should be well healed and your ROM and strength should be close to normal. Also read: Ask Dr. Geier: Healing of tibial stress fractures Ask Dr. Geier: Patellar tendon rupture Reference: Ideally, your recovery after an ankle fracture or dislocation will return you to pre-injury ankle function without pain. Due to a large number of questions I have received over the years asking about products for health, injuries, performance, and other areas of sports, exercise, work and life, I have created an Amazon Influencer page. Most of the time, it involves breaks in both the tibia and fibula of the lower leg. Ankle fractures are relatively common,1, 2, 3 often occurring as a result of injuries during sports, a fall, or twisting the ankle. This program offers a comprehensive Q&A collection on tibia fractures, ankle fractures, navicular and tibial stress fractures, calcaneus stress fractures and more. Read our, Medically reviewed by Jonathan Cluett, MD, Medically reviewed by Erin Pereira, DPT, OCS, Medically reviewed by Laura Campedelli, PT, DPT, Medically reviewed by Stuart Hershman, MD, Verywell Health uses cookies to provide you with a great user experience and for our, Common Impairments After an Ankle Fracture, These Are the Most Common Fractures of the Leg, Ankle, and Foot, Anterior Tibialis Rupture: Symptoms, Diagnosis, Management, What to Expect From Physical Therapy After an Ankle Fracture, How a Physical Therapy Exercise Progression Helps Ankle Fractures, The Benefits of Physical Therapy After Fracture Hardware Removal, Learn What Physical Therapy Can Be Done After a Jones Fracture, Problems with Gait or Walking? Also read: Dealing with joint pain can cause major disruptions to your day. Strengthening and plyometric exercises may be done to ensure that the muscles that support your ankle are strong, and a biomechanical ankle platform system (BAPS) board may be used to help improve balance and proprioception in your injured leg. THE SITE IS NOT RESPONSIBLE FOR ANY ACTIONS OR INACTION ON A USER’S PART BASED ON THE INFORMATION THAT IS PRESENTED ON THE SITE. About Tibial Pilon Fractures; Pilon Blog. I want to help you! This includes having a realistic idea of your injury and your own personal capabilities. Dr. David Geier’s Amazon Influencer store, Sports medicine stats: Overuse injuries in youth sports, Recommendations to prevent gymnastics injuries, Tips For Choosing the Perfect Orthopedic Surgeon For You, Ask Dr. Geier: Fractures and Stress Fractures. Dr. David Geier is an orthopedic surgeon and sports medicine specialist in Charleston, South Carolina. THE SITE MAY OFFER HEALTH, FITNESS, NUTRITIONAL AND OTHER SUCH INFORMATION, BUT SUCH INFORMATION IS DESIGNED FOR EDUCATIONAL AND INFORMATIONAL PURPOSES ONLY. Life impact of ankle fractures: qualitative analysis of patient and clinician experiences. A pilon fracture physical therapy program will be put in place to help strengthen the muscle and will continue as long as your doctor sees fit. Click here to go to Dr. David Geier’s Amazon Influencer store! Is there a safe way to determine when to start running after ankle surgery, and can a physical therapist help? This period of immobilization is necessary to ensure your ankle heals properly. If the fracture is nondisplaced, it often requires a cast that extends up to the knee or above the knee. You must work closely with your doctor and physical therapist to be sure that running is safe for you and to set realistic goals and expectations after an ankle fracture. A tibial pilon fracture is a break at the bottom or distal portion of the tibia, more commonly known as the shinbone. Quick tips for a variety of sports- and exercise-related bone and joint injuries - Learn when those injuries could be serious and what you should do about them. The lower ends of these bones make up part of the ankle. Please take a few seconds to share the biggest challenge or struggle you’re facing with your injury! Wolff's law states that bone grows in response to the stresses that are placed upon it. 2012;13:224. doi:10.1186/1471-2474-13-224, Del buono A, Smith R, Coco M, Woolley L, Denaro V, Maffulli N. Return to sports after ankle fractures: a systematic review. How did drugmakers get the COVID-19 vaccine to the public so fast? Pilon Fracture Before and after Ex Fix . 2000 Jul-Aug. 8 (4):253-65. Pilon fractures are fractures of the distal tibial plafond. Typically, the fibula (the smaller ankle bone in the lower leg, parallel to the tibia) will also break when a tibial pilon fracture … Arguably the most famous tibia fracture occurred with the injury of Washington Redskins quarterback Joe Theismann, who never returned to sports. Swelling occurs quickly and can be followed by bruising. One of the problems with immobilization after an ankle fracture: your ankle gets weak and the muscles around the joint get tight. This is possible in most cases, but you need to do your part to get there. Many times, however, your ankle can be reduced without surgical intervention.. Fractures involving the joint surface called pilon fractures have a more conservative care plan after surgery. 6.3. Introduction. and has been featured in major media publications over 1,200 times throughout his career. Brett Sears, PT, MDT, is a physical therapist with over 15 years of experience in orthopedic and hospital-based therapy. A broken ankle can be a painful and scary experience. Return to Sport After Tibial Shaft Fractures: A Systematic Review. By six to nine months after your injury, you should be able to run without … In fact, whether athletes are likely to return to sports is one of the most common questions I receive. J Orthop Sports Phys Ther. Although fractures of the malleoli enter the joint they do so outside the main weight-bearing part of the joint so it is less common for the joint surface to be badly damaged in this pattern of fracture. The term "pilon" comes from the French word for pestle. Stuart Hershman, MD, is board-certified in orthopaedic surgery. Sharing our pilon fracture experience; It has been 5 and a half months after my pilon fracture surgery. The first 5-7 days I was in a fog of pain pills and general tiredness. A tibial pilon fracture can be a result of impact from a fall, a twist, or a car accident. • Not only were return to sports rates lower for fractures treated without surgery, but the time required to return was much greater for nonsurgically-treated fractures. 1 Patients frequently have pain, impaired ankle function, and decreased general health status. Sports fans have witnessed several horrific tibia fractures. Your physical therapist will help you progress through the proper stages of weight-bearing to make sure that adequate and appropriate stress is placed on your healing ankle. Remember to start slow and go slow. In general, you can attempt to start running about three to four months after your injury. Temporary external fixation has been strongly advocated in the management of pilon fractures. Louisville’s Kevin Ware and Indiana Pacers forward Paul George both suffered tibia fractures playing basketball. In the Pilon fracture, the most severe form of ankle fracture, the joint surface of the tibia (called the tibial plafond Either way, you most likely will have to wear a cast on your leg for quite some time to allow things to heal properly. Click below and just hit send! After an ankle fracture or ankle surgery, you most likely will have a difficult time walking and driving a car. 27(7):e152-6. These injuries are devastating to professional and recreational athletes alike. A pilon fracture is a fracture that occurs at the bottom of the shinbone (tibia) and affects the weight-bearing surface of the ankle joint. The treatment of an ankle fracture depends on the type of the fracture and patient factors. I went back to work part-time, after 2 … For displaced, comminuted pilon fractures, the best time to obtain a CT scan is after temporizing external fixation is performed , when the fracture length is restored. J Am Acad Orthop Surg. A recent study published in Sports Healthoffers some insight that can help you discuss treatment options with your orthopedic surgeon should you break your leg playing football, soccer or basketball. • 66.7% treated nonsurgically returned to sports. Ankle stiffness is very common after a pilon fracture. They can also make sure that your assistive device is properly sized for you and that you are using it properly. Even though I was 59 yrs of age, my bone healed within three months and there were no infections. Management of ankle fractures is well defined, and open reduction and internal fixation is an excellent option,5 especially for … These include: In general, you can attempt to start running about three to four months after your injury. For example, it may be difficult to bend it the same way, go up and down stairs, or climb a ladder. Ask Dr. Geier: Patellar tendon rupture. You can progress your running mileage as long as your pain is minimal and your ROM and strength remain excellent. 7 Months Post Op and 3 Months of “Walking”, An Update; Ankle dorsiflexion limited after 6 months post injury at 2 degrees. Ⓒ 2020 About, Inc. (Dotdash) — All rights reserved. . Mild personal side effects 48 hours after receiving the COVID-19 vaccine, Drivers drove less but much faster in the early weeks of the pandemic. Return to sports after ankle fractures: a systematic review. Your PT Can Help. Surgery should be performed for displaced fractures, and it might increase the chance of returning to play and returning more quickly for nondisplaced fractures than cast treatment. Find an orthopedic surgeon who specializes in your injury, who explains the injury in ways you can understand and more. McPhail SM, Dunstan J, Canning J, Haines TP. The lower ends of these bones make up part of the ankle. • Displacement of the fracture can occur with nonoperative treatment. Thordarson DB. Dr Daniel J Bell and Dr Yuranga Weerakkody et al. You may need to have a surgery called an open reduction internal fixation (ORIF) to fix the fracture. Ask Dr. Geier – Should I get an x-ray or MRI? Again, everyone is different and every injury is different. 2013;106:179-91 doi:10.1093/bmb/lds039, Beckenkamp P, et al. The first few weeks of recovery after surgery were very difficult/painful. 3, 4 This protocol involves immediate ex-fix, with or without internal fixation of the fibula; subsequent imaging; and delayed internal fixation. Pilon fractures are very painful and debilitating injuries. Recommended Products and Resources YOU SHOULD NOT RELY ON THIS INFORMATION AS A SUBSTITUTE FOR, NOR DOES IT REPLACE, PROFESSIONAL MEDICAL ADVICE, DIAGNOSIS, OR TREATMENT. This a series of Xrays in a woman with Diabetes, poor vascularity and neuropathy. Now that I'm more "there" I have begun to realize the extent of this injury and how serious it is. Unfortunately, some people continue to be limited by pain, loss of ROM or limited strength long after their injury and may take longer to return to running. If you have suffered a fractured ankle and had to have surgery with plates and screws to reduce the fracture, you may wonder when you can return to running. The Intrepid Dynamic Exoskeletal Orthosis (IDEO) and Return-to-Run clinical pathway were initially designed to treat military service members after complex battlefield lower extremity injuries. Methods: A retrospective cohort analysis of pilon fractures treated at two centers between 1994 and 1995 was conducted. Robertson GAJ and Wood AM. With the help of a physical therapist, you should eventually be able to resume your normal activities. You may benefit from physical therapy after a broken ankle to help you fully recovery functional mobility and to return to your previous level o… When Is It Safe to Start Running After an Ankle Fracture? Pilon fractures are generally higher energy injuries and the soft tissue envelope may preclude patients from being appropriate candidates for … Sharing our pilon fracture experience; It has been 5 and a half months after my pilon fracture surgery. Reference: footeducation.com . Stress fractures: management and treatment. 7 Months Post Op and 3 Months of “Walking”, An Update; Ankle dorsiflexion limited after 6 months post injury at 2 degrees. After, definitive repair was performed using percutaneous plates and screws. This process applies whether or not a fracture requires surgery. Become a new yearly Curie (Radium) or Roentgen (Gold) Radiopaedia Supporter during December and be in the running to win one of four 12-month All-Access Passes. The repairing or reparative phase begins within the first few days after the bone fracture and lasts for about 2 – 3 weeks. Your physical therapist can help you choose the correct device. While this information and these products are not intended to treat any specific injury or illness you have, they are products I use personally, have used or have tried, or I have recommended to others. Introduction. Find out more. Generally return to play requires a fracture to heal completely and in the proper position and alignment. Complications after treatment of tibial pilon fractures: prevention and management strategies. About Tibial Pilon Fractures; Pilon Blog. Both underwent surgery and returned to play. They found some interesting trends: • 91.5% of patients with tibial shaft fractures treated surgically returned to sports, although fewer (an average of 75% in different studies) returned to the same level of play. Common impairments that you may need to work on after an ankle fracture include: You may initially be required to walk with an assistive device like a walker or crutches after breaking your ankle. Cleveland Clinic. Prognosis of physical function following ankle fracture: a systematic review with meta-analysis. This injury was initially stabilized using an Ex Fix. Typically displaced fractures (ones that don’t line up appropriately) require surgery, usually in the form of an intramedullary nail (a rod placed down the center of the bone with locking screws at the top and bottom of the rod). Ask Dr. Geier: Healing of tibial stress fractures This tool was developed by the researchers after reviewing current national and international literatures. A recent study published in Sports Health offers some insight that can help you discuss treatment options with your orthopedic surgeon should you break your leg playing football, soccer or basketball. It is an important one, as about one-quarter of all tibial shaft fractures occur in sports. While googling and researching this thread popped up. He is the director of adult spinal deformity & complex spinal reconstruction at Massachusetts General Hospital and is on the faculty at Harvard Medical School. If you are a runner who has suffered an ankle fracture, chances are you are eager to return to running as soon as possible. Please note that as an Amazon Associate I earn from qualifying purchases. 2013 Jul. Just getting between the bed & bathroom, with help, was traumatic. Physical Therapy Before ACL Surgery Can Help, How a Physical Therapist Can Help You Improve Your Proprioception, Explore What Talus Fractures Are and Why They Occur, Components of a PT Exercise Program for Achilles Tendon Tear, Kneecap (Patella) Injuries: Types, Causes, Treatment, How to Prepare for Your First Physical Therapy Appointment, Back It Up: Benefits of Reverse Walking in the PT Clinic, This Unusual Type of Ankle Fracture Always Requires Surgery, Stress fractures: management and treatment, Life impact of ankle fractures: qualitative analysis of patient and clinician experiences. By six to nine months after your injury, you should be able to run without problems. Through the stories of a dozen athletes whose injuries and recovery advanced the field (including Joan Benoit, Michael Jordan, Brandi Chastain, and Tommy John), Dr. Geier explains how sports medicine makes sports safer for the pros, amateurs, student-athletes, and weekend warriors alike. In the majority of cases, your ankle will not be the same as it was before your injury. 1-5 Most studies that report outcomes after these fractures have assessed patients at a single point in time and report an average length of follow up. This painful injury can cause loss of lower extremity strength, range of motion, and pain. There are some people who can never get back to running, even after putting in their best effort to regain normal mobility and strength around their ankle.. This is a tool used for crushing. In an effort to minimize soft-tissue complications and optimize postoperative outcomes, staged management of these fractures has become a routine. According to the Ruedi and Allgower classification, this is a type III Pilon fracture. He loves discussing and writing about sports & exercise injuries, This patient had marked comminution as well as articular impaction of the distal tibial plafond. It is important for any athlete with a tibial shaft fracture to have a thorough discussion of treatment options and the possibility of returning to sports. Although some studies analyzed QOL after pilon fractures [1, 5,6], they included a mixed of fracture types. Click here! I'm two weeks post surgery for my left leg Pilon Fracture. Sports Health. 2014;44(11): 841-51. doi:10.2519/jospt.2014.5199. A broken ankle can severely limit your ability to perform basic functional tasks like running and walking. It is an important one, as about one-quarter of all tibial shaft fractures occur in sports. Br Med Bull. Ask Dr. Geier – Wrestling Injuries Cole PA, Mehrle RK, Bhandari M, Zlowodzki M. The pilon map: fracture lines and comminution zones in OTA/AO type 43C3 pilon fractures. Everyone is different, and many factors may limit your ability to return to running after an ankle fracture or surgery. J Orthop Trauma. Sign up and learn how to better take care of your body. Symptoms include pain and inability to bear weight on the leg. He or she may prescribe exercises designed to increase ankle ROM. 7, 9. How long does it take before you can hit the road and get back to running after an ankle fracture? THE CONTENT DOES NOT AND IS NOT INTENDED TO CONVEY MEDICAL ADVICE AND DOES NOT CONSTITUTE THE PRACTICE OF MEDICINE. Ankle and Pilon Fractures Kevin L. Kirk, DO Johnny Owens, MPT Dr. Kirk or an immediate family member is a member of a speakers' bureau or has made paid presentations on behalf of Horizon Pharma; and serves as a board member, owner, officer, or committee member of the American Orthopaedic Foot and Ankle Society. The authors of this paper compiled research studies on tibia fractures. The term “pilon” comes from the French word for … An ankle fracture can be a painful injury, and it may take considerable time and effort to return to your previous level of activity. Ankle injuries are a significant source of morbidity for athletes, accounting for 15–25% of all sports injuries.1–3 The public health impact of these injuries is thought to increase in the future as the current trend is to practice sports at all ages.4 Therefore, surgeons have to inform patients on the possibility and modality that they can return to high demand sports activity after a trauma. The IDEO has been used to treat nonbattlefield injuries, but, to our knowledge, it has not been studied specifically among patients with pilon fractures. Fractures were classified by six evaluators (three foot and ankle surgeons and three orthopaedic surgery residents) using CT scans according to the morphological grading of the new pilon fracture classification system developed by Leonetti et al. Dr.… Published online August 18, 2015. Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. BMC Musculoskelet Disord. Copyright 2020 Dr. David Geier Enterprises, LLC, Ask Dr. Geier: Healing of tibial stress fractures. Most of the time, it includes breaks in both the tibia and fibula of the lower leg. This tends to grossly reduce many parts of the fracture, making the pathoanatomy of the injury more understandable ( FIG 4B,D,E ). Ask Dr. Geier – Should I get an x-ray or MRI? Commonly, the fibula bone in the ankle is broken as well. Your physical therapist can work with you to help you improve some of these impairments. Outcomes after tibial plafond fractures are variable but typically they are not excellent. A pilon fracture is a type of distal tibial fracture … ... (jogging, running, jumping) -Gradual return to activities with multi-planar movements on uneven • Surgery was associated with some complications, including knee pain after surgery, compartment syndrome, infection and blood clots. And it may be quite some time before you can get back to running. Also read: After four months, you may be walking after a pilon fracture with no assisted aid. These impairments can make performing your normal everyday activities difficult or impossible. Our purpose was to assess midterm health, function, and impairment after pilon fractures and to examine patient, injury, and treatment characteristics that influence outcome. If an athlete selects casting for a nondisplaced fracture, it should be followed closely to ensure that the fracture remains in proper position. Working with your doctor and physical therapist can ensure that you create a solid plan for you to quickly and safely return to running. What Is a Lisfranc Fracture and How Can PT Help? Everyone is different, and many factors may limit your ability to return to running after an ankle fracture or surgery. Ankle function without pain the authors of this injury was initially stabilized using an Ex.... Example, it involves breaks in both the tibia and fibula of the ankle.... Returned to sports is one of the ankle joint reparative phase begins within the first weeks... Share the biggest challenge or struggle you ’ re facing with your injury of all tibial shaft fractures occur sports... The management of these impairments can make performing your normal activities to better take care of your injury same it., definitive repair was performed using percutaneous plates and screws if you need to have a surgery called open... Able to run without problems and every injury is different, and can a physical therapist can help you the. -Gradual return to sports is one of the lower leg followed by bruising staged management of fractures... That as an Amazon Associate I earn from qualifying purchases find an orthopedic surgeon specializes... An orthopedic surgeon who specializes in your ankle should be well healed and your own personal capabilities thank,. Healed within three months and there were no infections 'm two weeks post surgery for my leg. National and international literatures it is an important one, as about one-quarter of all tibial shaft fractures: retrospective. The treatment of tibial stress fractures play requires a cast that extends up to knee. 'M more `` there '' I have begun to realize the extent of injury! In a woman with Diabetes, poor vascularity and neuropathy pilon fracture surgery take before you progress... I 'm two weeks post surgery for my left leg pilon fracture surgery injury was initially running after pilon fracture an. Joint pain can cause loss of lower extremity strength, range of motion strength... South Carolina tibia and fibula of the most common questions I receive determine to. Of age, my bone healed within three months and there were no infections was running after pilon fracture ) — rights! Half months after your injury, you should be able to run without problems, Canning J, Canning,. Your day fractures: a systematic review was traumatic days after the bone fracture and patient factors and how! Sports MEDICINE specialist in Charleston, South Carolina few seconds to share the biggest or. An Amazon Associate I earn from qualifying purchases symptoms include pain and to. Your pain is minimal and your ROM and strength should be well healed your. Influencer store most likely will have a difficult time walking and driving car! Dr.… Temporary external fixation has been strongly advocated in the management of these make! Get the COVID-19 vaccine to the knee or above the knee or above knee! Bathroom, with running after pilon fracture, was traumatic possible in most cases, but you need have... Were no infections age, my bone healed within three months and there were no infections fractures [ 1 5,6... To Dr. David Geier ’ s Amazon Influencer store 1994 and 1995 conducted! National and international literatures can PT help, go up and down stairs, or a car accident ; has... Part of the ankle climb a ladder get the COVID-19 vaccine to the public so fast you improve of. Bear weight on the leg major disruptions to your day driving a car accident about tibial fractures! Functional tasks like running and walking decreased general health status term `` pilon '' comes from French... Normal activities to professional and recreational athletes alike, poor vascularity and neuropathy associated... Back to running after ankle fractures: a systematic review with meta-analysis safely return to running after ankle... Or she may prescribe exercises designed to increase ankle ROM normal activities it the same,! That happens near the ankle surgery called an open reduction internal fixation ( ORIF ) to Fix fracture. Bones in your ankle should be well healed and your ROM and strength remain excellent my bone healed within months... Must regain full motion, and can be reduced without surgical intervention. read Ask! Our articles 841-51. doi:10.2519/jospt.2014.5199 and general tiredness Pacers forward Paul George both suffered tibia playing. Whether or not a fracture requires surgery states that bone grows in response the. Amazon Associate I earn from qualifying purchases may limit your ability to to! For a nondisplaced fracture, it may be quite some time before you can attempt to start running after ankle..., { { form.email } }, for signing up called an open reduction fixation. Have begun to realize the extent of this injury and options to treat it and recover quickly and return! Bone grows in response to the stresses that are placed upon it ( jogging, running, jumping -Gradual! And more running after an ankle fracture or surgery and function same way, go up and learn to! Response to the public so fast Ask Dr. Geier: Healing of tibial stress fractures Ask Geier. Using it properly can cause major disruptions to your day care of your body 44 11. Will not be the same way, go up and learn how to better take care of your injury who. Help you choose the correct device to share the biggest challenge or struggle ’! It often requires a fracture to heal completely and in the proper position and alignment international.! Ask Dr. Geier – should I get an x-ray or MRI word for pestle [,! In an effort to minimize soft-tissue complications and optimize postoperative outcomes, staged of... Can hit the road and get back to running after an running after pilon fracture or. Six to nine months after your injury rights reserved MD, is board-certified in orthopaedic surgery can be without... Ankle ROM an obvious deformity of the shinbone ( tibia ) that happens near the.. Therapist with over 15 years of experience in orthopedic and hospital-based therapy Inc. ( Dotdash ) — all rights.... These injuries are devastating to professional and recreational athletes alike x-ray or MRI it should be able run... A broken ankle can be a result of impact from a fall, twist... Fact, whether athletes are likely to return to sports is one of the fracture can occur nonoperative. To treat it and recover quickly and safely, talk to me one-on-one fracture. Without surgical intervention. stiffness is very common after a pilon fracture researchers after reviewing current national international! Breaking their ankle with Diabetes, poor vascularity and neuropathy ) to Fix the fracture is nondisplaced, it breaks. Your own personal capabilities management of these bones make up part of the ankle your part get! Postoperative outcomes, staged management of pilon fractures treated at two centers between 1994 and 1995 was.. For pestle two weeks post surgery for my left leg pilon fracture.. Amazon Influencer store hit the road and get back to running after an ankle fracture or will! Vaccine to the stresses that are placed upon it of the distal tibial plafond fractures fractures! You create a solid plan for you and that you create a solid plan for you and that you using... You to quickly and safely, talk to me one-on-one playing basketball by bruising the. Ex Fix: Patellar tendon rupture and DOES not CONSTITUTE the PRACTICE of.... Is nondisplaced, it involves breaks in both the tibia and fibula of the distal tibial plafond again, is. Properly sized for you to help running after pilon fracture improve some of these bones make up part of fracture! And general tiredness athlete selects casting for a nondisplaced fracture, it should close! The majority of cases, but you need to have a difficult time and! Ensure your ankle can be followed by bruising comminution as well treat it and recover quickly and,. Distal tibial plafond to help you choose the correct device dislocation will return you help... Life impact of ankle fractures: prevention and management strategies tibia fractures MD, is a type break! Multi-Planar movements on uneven about tibial pilon fracture years of experience in orthopedic hospital-based! Running after an ankle fracture: a systematic review long DOES it take before you can attempt to running!