TIBIAL PLAFOND FRACTURES. RETROSPECTIVE REVIEW.

Abstract

Background: Tibial plafond fractures are caused by severe axial compression forces and are associated with soft tissue injuries. These fractures are difficult to treat and the risk of complications is high.

Methods and Materials: A retrospective study of tibial plafond fractures was performed at our hospital between 2003 and 2009 and 51 patients were evaluated (51 fractures). The fracture type was classified according to the OTA classification system. 10 fractures were described as type A fractures (A1 = 3, A2 = 3, A3 = 4) (19.60%), 15 were type B fractures (B1 = 0, B2 = 9, B3 = 6) (29.4%) and 26 were type C fractures (C1= 3, C2=13, C3 = 10) (51%).

Results: The average age was 47.8 years. Cases comprised 25 accidental falls (49%), 13 traffic accidents, (2.5%), 7 autolysis attempts (13.7%), 4 sports accidents (7.8%) and 2 industrial accidents (3.9%). 15 patients were initially treated with external fixators, mainly those who had type C fractures and fractures where the soft tissues were seriously damaged (21.6%). Subsequently the tibia was treated with plate fixation. Mean follow-up period was 87.78 months. Patients were required to fill in 2 quality life questionnaires after the surgical treatment. results obtained with both scales (AOFAS and FFI) were compared.

The complications rate was 14%. The main complications were superficial infections, posttraumatic arthritis and non-union fractures. One case presented a superficial infection (2%) and 6 patients suffered deep infections (11.8%).

Worst scores were observed in both scales with patients treated with type C fractures of the AO classification.

Conclusions:

• - Type C fractures have a worse prognosis

• - Using external fixators as initial stabilisation method improves the healing of soft tissues.

• - It is important to perform a CT scan in the preoperative planification.

• - Tibial plafond fractures are still a challenge for the surgeon.