A Clinical Study of the Tibial Plafond Fractures

Lee, Byung Ill; Choi, Chang Uk; Kim, Hak Hyun; Kim, Jong Chul

Abstract

A fracture of the distal tibial articular surface is fortunately an uncommon injury, since it can be exeptionally difficult to manage. The term plafond is gar'nering general acceptance since there is no anatomic name for the specific location of this fracture. The term was introduced more than 50 years ago in American orthopaedic literature to describe these injuries. The literal meaning of plafond is the underside of a floor, i.e., a ceiling, so the term refers to that portion of the distal articular surface of the tibia which articulates with the superior articular surface of the talus. It excludes the medial malleolar joint surface. Fracture of the plafond have also been called compression, pylon, Malgaigne and explosion fractures. A plafond fracture is defined as one caused primarily from direct axial compression resulting in elevation andgor displacement of all or part of the distal articular surface of the tibia, excluding isolated or combined fractures of the medial and posterior malleoli that are recognizably caused by rotational forces. We reviewed 16 cases(14 patients) of tibial plafond fractures treated at the Department of Orthopaedic Surgery of Soan Chun Hyang University Hospital during 8.5 years period from June 1974 to December 1982. The longest duration of follow-up was 5 years and 6 months, the shortest, 6 months, and the average, 1 year and 6 months. They were classified according to Moore et al., and assessed according to the criteria of Joy et al. The following results were obtained: l. Of the 14 patients, male were 12, female were 2. 2. The average age of the patients was 38 years old. 3. The most common causative injury was fall-down. 4. The most common type in radiological study was dorsiflexion type. 5. In method of treatment, operative treatment was done in 9 cases and non-operative in 6 cases. 6, The average duration of the cast immobilization in non-operative treatment was 12 weeks and operative, 10 weeks. 7. Better results were obtained by operative treatment than non-operative treatment. 8, The complications were encounted in 1 case of non-operative, 2 cases of operative treatment. 9. We agree that the accurate anatomical reduction with rigid internal fixation assures better results in the tibial plafond fracture.