Early clinical and radiographic outcomes of a mini-fragment, low profile plating system in tibial plafond fractures

Abstract BACKGROUND: Although efficacy is related to many factors, the surgical approach is one of the most important intervention factors for complex ankle fractures. Ankle fractures involving the distal tibial plafond frequently present a surgical challenge in choosing which incisions will be best for surgical treatment. Here we present an innovative fibular notch approach for the treatment of some specific ankle fractures and present a series of patients with either functional or radiographic outcomes.METHODS: Twenty two patients with distal tibial plafond fractures with concomitant fibular and distal tibiofibular syndesmosis injuries were treated through a fibular notch approach in this retrospective study. The details of the surgical technique were reviewed from the operative notes. Relevant data were reviewed from the medical records. The quality of fractures and syndesmosis reduction was examined using CT scans, and lateral stability of the ankle was assessed by physical examination and stress radiographs. The American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS) score was implemented for clinical functional assessment.RESULTS: All surgeries were successfully performed via the fibular notch approach as the primary approach with excellent intraoperative visualization. Postoperative radiography revealed satisfying restoration of all fractures and syndesmosis. All fractures healed with an average time of 17.3±3.6 weeks. Mild posttraumatic osteoarthritis (PTOA) was present in 4 patients. The average AOFAS score was 88.8 at the last followup.CONCLUSIONS: The fibular notch approach is a safe and reliable approach for the treatment of specific ankle fractures involving the distal tibial plafond. This approach provides excellent direct visualization of the fragments and articular surface without significantly increasing iatrogenic injuries. Satisfactory radiographic and clinical results were observed, and further clinical and anatomical studies are recommended to ascertain the feasibility of this approach in the treatment of complex distal tibial fractures.

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A fibular notch approach for the treatment of ankle fractures involving the distal tibial plafond

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02270-3 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Tong Liu ◽

Yiheng Cheng ◽

Wenqing Qu

Keyword(s):

Articular Surface ◽

Clinical Results ◽

Ankle Fractures ◽

Aofas Score ◽

Radiographic Outcomes ◽

Tibial Plafond ◽

Operative Notes ◽

Tibial Plafond Fractures

Abstract Background Although efficacy is related to many factors, the surgical approach is one of the most important intervention factors for complex ankle fractures. Ankle fractures involving the distal tibial plafond frequently present a surgical challenge in choosing which incisions will be best for surgical treatment. Here, we present an innovative fibular notch approach for the treatment of some specific ankle fractures and present a series of patients with either functional or radiographic outcomes. Methods Twenty-two patients with distal tibial plafond fractures with concomitant fibular and distal tibiofibular syndesmosis injuries were treated through a fibular notch approach in this retrospective study. The details of the surgical technique were reviewed from the operative notes. Relevant data were reviewed from the medical records. The quality of fractures and syndesmosis reduction was examined using CT scans, and lateral stability of the ankle was assessed by physical examination and stress radiographs. The American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS) score was implemented for clinical functional assessment. Results All surgeries were successfully performed via the fibular notch approach as the primary approach with excellent intraoperative visualization. Postoperative radiography revealed satisfying restoration of all fractures and syndesmosis. All fractures healed with an average time of 17.3 ± 3.6 weeks. Mild posttraumatic osteoarthritis (PTOA) was present in 4 patients. The average AOFAS score was 88.8 at the last follow-up. Conclusions The fibular notch approach is a safe and reliable approach for the treatment of specific ankle fractures involving the distal tibial plafond. This approach provides excellent direct visualization of the fragments and articular surface without significantly increasing iatrogenic injuries. Satisfactory radiographic and clinical results were observed, and further clinical and anatomical studies are recommended to ascertain the feasibility of this approach in the treatment of complex distal tibial fractures.

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Long-term results of tibial plafond fractures treated with open reduction and internal fixation

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/bf00443458 ◽

1991 ◽

Vol 110 (6) ◽

pp. 277-283 ◽

Cited By ~ 47

Author(s):

C. Etter ◽

R. Ganz

Keyword(s):

Internal Fixation ◽

Open Reduction ◽

Long Term Results ◽

Tibial Plafond ◽

Tibial Plafond Fractures

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Syndesmosis and Syndesmotic Equivalent Injuries in Tibial Plafond Fractures

Journal of Orthopaedic Trauma ◽

10.1097/bot.0000000000001363 ◽

2019 ◽

Vol 33 (3) ◽

pp. e74-e78 ◽

Cited By ~ 2

Author(s):

Justin M. Haller ◽

Michael Githens ◽

David Rothberg ◽

Thomas Higgins ◽

David Barei ◽

...

Keyword(s):

Tibial Plafond ◽

Tibial Plafond Fractures

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Influence of reduction quality on functional outcome and quality of life in treatment of tibial plafond fractures: a retrospective cohort study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-2932-2 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Maxim Privalov ◽

Finn Euler ◽

Holger Keil ◽

Benedict Swartman ◽

Nils Beisemann ◽

...

Keyword(s):

Quality Of Life ◽

Functional Outcome ◽

Joint Surface ◽

Intraoperative 3D Imaging ◽

Tibial Plafond ◽

Sf 36 ◽

Surface Irregularities ◽

Tibial Plafond Fractures

Abstract Background The aim of the study was to evaluate the impact of reduction quality, using intraoperative 3D imaging, on quality of life and functional outcome in the operative treatment of tibial plafond fractures. Methods A group of patients with tibial plafond fractures was re-examined. The operative treatment was performed between September 2001 and October 2011. The follow-up examination was at least 2 years after the final surgical procedure. Final reduction result was assessed intraoperatively using a mobile 3D C-arm. A categorization with regard to descriptive parameters as well as type and size of joint surface irregularities was performed. Follow-up results were evaluated using: Olerud and Molander (O & M) score, Short-Form-36 (SF-36) score, movement deficit, Kellgren and Lawrence grade of osteoarthritis, and pain intensity. Results 34 patients with operatively treated tibial plafond fracture could be re-examined. Reduction quality had the greatest influence on functional result measured by the O & M score (p = 0.001) and the PCS domain of the SF-36 score (p = 0.018). Significant differences with regard to O & M score (p = 0.000), SF-36 score (p = 0.001 to p = 0.02; without MCS domain), movement deficit (p = 0.001), grade of osteoarthritis (p = 0.005) and pain (p = 0.001) could be verified under consideration of the reduction quality. The group with the anatomically more accurate reduction also showed a better result for clinical follow-up and quality of life. Furthermore, it is not the type of joint surface irregularity that is always decisive, but rather the size. Conclusions Despite other relevant factors, it appears that reduction quality –which can be analyzed with intraoperative 3D imaging– plays the most important role in postoperative quality of life and functional outcome. Corrections should therefore be performed on joint surface irregularities with a size above 2 mm.

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