Pilon Fracture with Associated Achilles Tendon Rupture: Case Report and Review of the Literature.

Introduction: Ankle fractures and Achilles tendon ruptures most commonly occur as isolated injuries. The simultaneous occurrence of an ankle fracture with an Achilles tendon rupture is rare. It may be overlooked during initial evaluation, particularly in elderly patients or in the presence of distracting injuries. Previous reports have described Achilles tendon rupture in association with medial malleolar, bimalleolar, trimalleolar, and distal tibial fractures. To our knowledge, this is the first reported case of an Achilles tendon rupture occurring in conjunction with a pilon fracture. Reporting this case is important to raise awareness of this uncommon injury pattern and to emphasize the need for comprehensive clinical assessment in ankle trauma. Case Report: A 78-year-old male with a history of Parkinson's disease sustained a right ankle injury after falling from a ladder. He initially presented to the emergency department with ankle pain and superficial lacerations. Radiographs were obtained, but no fracture was diagnosed. Upon follow-up with an orthopedic surgeon, advanced imaging and physical examination revealed a fracture of the tibial plafond with an ipsilateral Achilles tendon rupture. The patient subsequently underwent open reduction and internal fixation of the pilon fracture and surgical repair of the Achilles tendon. Conclusion: This case highlights an exceptionally rare injury combination that can be easily missed during initial evaluation. It underscores the importance of maintaining a high index of suspicion and performing thorough physical examination and appropriate imaging when assessing ankle trauma, particularly in elderly patients. This report contributes a novel injury pattern to the orthopedic literature and demonstrates that concurrent operative management of both injuries can be safely performed in selected patients. Increased awareness of this association may help prevent delayed diagnosis, reduce complications, and improve functional outcomes in future cases.