Intraoperative Imaging of the Tibial Plafond Fracture: A Potential Pitfall

Abstract

In severe fractures of the tibial plafond multiple forms of internal and external devices are frequently used for fixation. In these circumstances hardware may obscure the lateral view making it impossible to obtain adequate lateral radiographs to assess fracture reduction and joint line congruity. In this scenario, the anteroposterior radiograph is frequently relied upon to confirm the anatomic relationship of the displaced fragments. However, this view fails to accurately characterize reduction in the entire joint line and, intra-operatively, may mislead the surgeon to accept a reduction as anatomic when intra-articular incongruity still exists. Strict attention to pre-operative radiographs and the use of additional rotated views may aid the surgeon in this setting to assess fracture reduction and joint line congruence.

Factors affecting the results of tibial pilon fractures treated with open reduction internal fixation

“…In all patients, bone union was achieved in an average of 16.2 weeks [12][13][14][15][16][17][18][19][20][21][22] without the need for a second intervention aimed at union. No implant failure or varus collapse was observed.…”

“…Due to concerns of loss of reduction, ankle and knee movement exercises started for 16 patients between the 4th and 6th weeks. Patients were given partial load in 11 weeks in average [8][9][10][11][12][13][14][15][16]. The average follow-up duration of the patients was 43 months.…”

“…It is recommended in the literature that for cases wherein the patient cannot be operated upon in the early stages, the surgical intervention be delayed 7-10 days in order to avoid complications related to the healing of the wound [15,16]. In this study, the surgical treatment took place in an average of 7 days [2][3][4][5][6][7][8][9][10][11][12][13][14][15] after admission to the hospital.…”

The Use of Medial and Lateral Surgical Approaches for the Treatment of Tibial Plafond Fractures

“…The use of the anterior approach has two inherent problems: access to fracture fragments that are not directly anterior, and difficulty in judging the articular reduction without full visualization of the articular surface. 12 CT studies of the articular injury in pilon fractures show a high degree of fracture fragments along the syndesmosis joint, with a high incidence of medial malleolar shear-type fragments. 13 Furthermore, judging articular reduction with fluoroscopic imaging without direct visualization can be difficult.…”

“…13 Furthermore, judging articular reduction with fluoroscopic imaging without direct visualization can be difficult. 12 Also, the anterior incision is in the normal plane of maximal motion of the soft tissue, which can create potential problems if scarring occurs. These drawbacks have led others to try alternative approaches to visualize and reduce specific components of a pilon fracture.…”