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

Purpose: We set four objectives: compare compression plate with locking screw, assess bone graft usefulness, assess utility of resection and compression of fracture site, and determine prognostic factors.

Materials and methods: A multicentre study was carried out including Sant Pau, Valle de Hebròn and IMAS hospitals in Barcelona. 54 surgical cases treated from 1994 to 2003 were included for retrospective study. Three groups of factors were analysed: familial, factors associated with the initial trauma and those associated with the surgical procedure. We studied the statistical relation to consolidation, consolidation time and postoperative complications.

Results: The following factors significantly enhanced consolidation (p< 0.05): treatment with nail in atrophic pseudoarthrosis and plate in hypertrophic. Consolidation time was significantly shortened (p< 0.05) if fractures were initially simple (type A) and for those initially treated conservatively. Postoperative complications were reduced (p< 0.05) in fractures that were initially simple (type A).

Conclusions: There were no differences between the two implants studied in terms of consolidation, consolidation time and complications. However, cases of atrophic pseudoarthrosis had a better outcome with nails and the hypertrophic cases with plates. Bone grafts did not improve results. Compression of the fracture site was a determining factor in achieving consolidation; therefore, open intramedullary nailing should be performed to this end. Simple fractures and fractures initially receiving conservative treatment were good prognostic factors following pseudoarthrosis surgery.