A Clinical Study of the Tibial Plafond Fractures

Park, Heui Jeon; Cho, Yong Moon

Abstract

Fractures of the ankle joint that involve the tibial plafond result from axial compression and rotational forces causing variable degrees of rnetaphyseal disruption, articular damage, and malleolar displacement. Management of these fractures has been described as difficult and often discouraging. Recommended treatments have included manipulation and cast application, calcaneal traction using pins in plaster or external fixators, vertical transarticular pin fixation, percutaneous pinning of large fragments and immobilization in a plaster cast, fibular stabilization alone, limited open reduction of so-called key fragments, immediate motion with the foot in traction, primary arthrodesis, and even immediate amputation. But, the best results of treatment reported for this fracture have followed early open reduction and rigid internal fixation to restore length, reconstruction of the plafond, primary cancellous bone grafting, tibial buttress plates, early motion, and prolonged non-weight-bearing. We reviewed 40 cases of tibial plafond fractures treated at the Department or Orthopaedic Surgery, Yonsei University, Wonju College of Medicine, during 7 years from January 1980 to December, 1986. The longest duration of follow-up was 5 years and 4 months, the shortest one was 6 months, and the average was 2 years. The results were as follows: 1. Of the 40 cases, male were 32, female were 8. 2. The major causes of the injury of the ankle were fall down and traffic accident. 3. The tibial plafond fractures were classified into 5 types, according to the degree of displacement of the plafond, articular comminution, and metaphyseal disruption. Our cases were relatively in even distribution. 4. Regardless of the types of the fracture, better results were obtained by treatment with open reduction and rigid internal fixation than by any other ones. 5. Complications including superficial wound infection (4 cases), osteomylitis. (2 cases), delayed union (2 cases), non-union (2 cases) were observed. 6. This study suggest that the important variables that influenced the clinical result were the type of fracture, the method of treatment, and the quality of the reduction.