EARLY RESULTS OF TIBIAL PLAFOND FRACTURES TREATED BY MODERN PLATING TECHNIQUES

Abstract

Introduction: Tibial plafond fractures constitute one of the most challenging injuries in orthopaedic surgery. Complications are common and clinical outcomes are generally poor. New guidelines for the management of these fractures and modern implants look forward to improving these results.

Material and Methods: 40 tibial plafond fractures treated by open reduction and internal fixation between January 2006 and December 2008 were included prospectively. Fractures were classified according to the AO classification. A CT scan was required in17 intraarticular fractures. Definitive surgery was delayed until soft tissue injury had been healed. Eleven patients underwent provisional external fixation. Mean time to surgery was of 7.5 days (range, 0 to 40 days). 27 fractures were treated by anteromedial plating, 12 with anterolateral plating and in one case two plates were required. Bone grafting was used in 8 cases. Plain radiographs were used to determine axial alignment and time to healing. Reduction of the articular surface was considered anatomical when there was less of 1mm of displacement. The Ankle Osteoarthritis Score (AOS) was analysed for pain and disability. Statistical analysis was performed with the SPSS 12.0 for Windows.

Results: According to the AO classification there were 22 Type A fractures, 9 Type B and 9 Type C. There were 7 open fractures (3 Type I, 3 Type II, 1 Type IIIA). Mean time to healing was of 18.1 weeks (8 to 32). Mean AOS score was of 41.2 points. There were 33 excellent and good results. There were 11 secondary losses of reduction and 5 non-union.

Clinical results were correlated with the quality of the reduction and with secondary displacement (p=1 and p=0.69 respectively). Anatomic reduction was more frequent in Type A (81.8%) and B (88.9%) fractures than in Type C (77.8%). There were not statistically significant differences in the quality of the reduction (p=0.88) or in the appearance of secondary displacement (p=0.46) between anteromedial or anterolateral plating. There were 6 infections (4 following anteromedial plating and 2 after anterolateral plating which was not statistically significant p=0.88). 13 patients developed soft tissue complications. Five requiring soft tissue fiaps.

Conclusion: Anteromedial and anterolateral plating of the distal tibia provide good clinical and radiological results. Infection rate is similar with both approaches. Appropriate timing of surgery can minimize soft tissue complications.