He served as assistant team physician to Chivas USA (Major League Soccer) and the United States men's and women's national soccer teams. A tibial plafond fracture (also known as a pilon fracture) is a fracture of the distal end of the tibia, most commonly associated with comminution, intra-articular extension, and significant soft tissue injury. 5, 9,10,31 Although the exact pathophysiological mechanisms of injury in OLTPs have not been determined, the stiffer articular cartilage lining the surface of the tibial plafond together with the . The landmarks used in the present study were the posterior condyles of the proximal tibia and the tibial plafond. ADVERTISEMENT: Supporters see fewer/no ads. tibial pilon fractures (types b3 and c according to the ao/ota fracture and dislocation classification) are predominantly the result of high-energy trauma and are often associated with comminuted joint surface, displacement, and often associated with extensive soft-tissue damage or open fractures. The Schatzker classification is a useful classification to categorize the mechanism of injury 1: Tibial plateau fractures are complex injuries that require adequate imaging to assess prior to fixation. 2017;22(1):147-161. doi:10.1016/j.fcl.2016.09.010. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. He sustained an injury to his right leg as seen in Figures A and B. Pathology Tibiatalar spurs are considered to have an important role in the development of anterior or anteromedial ankle impingement. The goal of therapy is to reduce the fracture and begin early mobilization. Diagnosis is typically made through clinical evaluation and confirmed with plain radiographs. tibial plateau fracture classification systems traditionally used by radiologists and orthopedic surgeons, including the schatzker and the arbeitsgemeinschaft fr osteosynthesefragen-orthopedic trauma association (ao-ota) classification systems, rely on findings at anteroposterior radiography and lack the terminology to accurately characterize A 55-year-old female presents to the emergency room after falling off her balcony. The tibial plateau is composed of two parts: Via the medial and lateral menisci the tibial plateau articulates with the medial and femoral condyles to form the tibiofemoral part of the knee joint. AJR Am J Roentgenol. Depression of a tibial plateau that is inadequately corrected results in a varus or valgus deformity and accelerated osteoarthritis. Book an appointment today! The external fixator secures the bone both above and below the fracture while avoiding the soft tissue that requires healing. Unable to process the form. [ 1 - 3] pilon fractures are very rare, with an Features of impaction are consistent with an axial loading mechanism, which is typically associated with this type of injury. Immediate definitive fixation of the tibia, and nonoperative treatment of the fibula, Immediate ankle-spanning external fixation device with consideration of immediate fixation of the fibula, followed by delayed reconstruction of the tibia, Placement of a temporary splint, elevation, and definitive fixation 1 week from injury, Immediate definitive fixation of the tibia and fibula, Immediate placement of a spanning Ilizarov fixator with limited internal fixation of the distal tibia and fibula. Once the soft tissues will allow definitive treatment, there are several options available in the treatment of tibial plafond fractures. In a pilon fracture, the Chaput fragment typically maintains soft tissue attachment via which of the following structures? 1. (OBQ12.199) External fixators are used for fixation in fractures that have significant soft-tissue damage. He presents with the radiographs shown in Figures A and B. The advantage of an ankle fusion is that is can provide a stable walking platform that has minimal pain. Soft tissue injuries (e.g. Read our, Physical Therapy Exercises After a Tibial Plateau Fracture, Halo Vest vs. Spinal Fusion: Uses, Benefits, Side Effects, and More, Common Fractures of the Leg, Ankle, and Foot, Medial Malleolus Fracture and Broken Ankle Treatment, What to Expect If You Have a Broken Shin Bone, Bimalleolar and Trimalleolar Ankle Fractures, Jones Fracture of the Foot: Symptoms, Treatment, and Recovery, Benefits of Physical Therapy After Fracture Hardware Removal, Physical Therapy After a Lisfranc Fracture and Dislocation, High-energy tibial pilon fractures: an instructional review, Primary arthrodesis for tibial pilon fractures. to cruciate and collateral ligaments) occur in approximately 10% of patients. The location you tried did not return a result. We report the imaging characteristics of osteochondritis dissecans of the tibial articular surface (tibial plafond). Even with proper treatment, there can be both short and long-term complications of ankle joint function. For such patients, the radiographic modality for measuring tibial torsion can be limited to CT. With the mobile application, an accurate torsional profile can be achieved without having to expose patients to high-dose radiation. Distal tibial triplane features, which constitute 6%-10% of epiphyseal injuries, are most accurately delineated and analyzed with computed tomography (CT). Casting may be favored in patients who have significant soft-tissue injury when surgery may not be possible. Microfracture of small lesions was the most common treatment utilized, and clinical and magnetic resonance imaging results were favorable, although data were heterogeneous. Content is reviewed before publication and upon substantial updates. Osteochondritis dissecans of the tibial plafond is a rare condition that may not be detectable on radiography. (OBQ06.8) High-energy tibial pilon fractures: an instructional review. (2006) ISBN: 9780550101853 -. Author(s), Article title, Publication (year), DOI. CONCLUSION. 1 Department of Radiology, University of California, Davis, 4860 Y St, Ste 3100, Sacramento, CA 95817. . Tibial plateau. This so-called post-traumatic arthritis is due to the cartilage damage sustained at the time of injury. By continuing to browse the site you are agreeing to our use of cookies. (OBQ12.161) Comminuted distal tibial fracture with coronally oriented fracture component, extending into the medial malleolus, with focal zone of depression comprising 30% of the tibial plafond with maximal depression of 1 cm. While the soft tissue is healing, the fractured bone and ankle joint will be immobilized. Macarini L, Murrone M, Marini S et-al. 1 All authors: Department of Radiology, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157-1088. . He noticed immediate pain and inability to bear weight on the affected limb. A 45-year-old male construction worker presents with right ankle pain after falling from a two-story building and landing on his right leg. Demographics and fracture characteristics of high and AL performers were compared. complex high energy mechanism involving varus OR valgus forces with significant axial loading; Radiographic features. We report the imaging characteristics of osteochondritis dissecans of the tibial articular surface (tibial plafond). Fibula Fibular fractures account for 10% of stress fractures. open reduction internal fixation of the fibula only, open reduction internal fixation of the tibia and fibula, removal of external fixator and conversion to a walking cast. Last's Anatomy. The other major factor that must be considered with these injuries is the soft tissue around the ankle region. She sustained the isolated, closed injury shown in Figures A and B. (OBQ05.157) She is otherwise healthy, but routinely smokes 30 cigarettes per day. We report the imaging characteristics of osteochondritis dissecans of the tibial articular surface (tibial plafond). Parameters measured included area of the OLT, tibial axis-medial malleolus angle (TMM), malleolar width (MalW), and talar surface angle (TSA; defined as the angle between the line perpendicular to the mid-diaphysis of the tibia and the talar joint surface . A 34-old-male was involved in a high speed MVC. The injury is closed, and soft tissues are intact upon arrival. Ho B, Ketz J. . What is the recommended initial treatment? Markhardt B, Gross J, Monu J. Schatzker Classification of Tibial Plateau Fractures: Use of CT and MR Imaging Improves Assessment1. Short leg splint placement and transition to short leg cast at 2 weeks, Closed reduction and spanning external fixation of the ankle, Open reduction and internal fixation of the fibula and tibia, Open reduction and internal fixation of the fibula with Blair arthrodesis of the ankle, Open reduction and internal fixation of the tibia and articulating external fixation of the ankle. Check for errors and try again. Tibial plateau fracture. Thank you. 2. [6] re-ported on a series of 30 patients who had os-teochondritis dissecans of the ankle. Impression fractures of the anterolateral tibial plafond (type 3) necessitate elevation with restoration of the joint surface, bone grafting of the impaction zone as needed and anterior buttress plating. (OBQ04.73) AJR Am J Roentgenol. Injury radiographs are shown in figures A and B. . ORIF with standard plating of the tibia and fibula, ORIF with locked plating of the tibia and fibula, ORIF with standard plating of the tibia and fibula and immediate bone grafting of tibia defect, External fixation of the tibia, ORIF of the fibula with standard plating, and immediate bone grafting of tibia defect, 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Tibial Plafond Fracture ORIF with Anterolateral Approach and Plate Fixation, Tibial Plafond Fracture External Fixation, Type in at least one full word to see suggestions list, Orthopaedic Summit Evolving Techniques 2021, Pro: Plate The Distal Tibial Extra-Articular Fracture: Get It Right! The treating surgeon decides to perform an open reduction internal fixation (ORIF) through combined anterolateral and medial approaches. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Varus collapse of the distal tibia at the time of injury, Use of more than one plate for definitive fixation of the tibia. Therefore,saying "medial tibial plateau" or "lateral tibial plateau", or, even worse, collectively referring to them as the tibial plateaus/plateaux, is anatomically-incorrect. Methods. The knee is a complex synovial joint that can be affected by a range of pathologies: ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Tap on the below button when you are Online. What is true regarding the anterolateral approach for this injury? {"url":"/signup-modal-props.json?lang=us\u0026email="}, Knipe H, Bell D, Hacking C, et al. Reference article, Radiopaedia.org (Accessed on 11 Dec 2022) https://doi.org/10.53347/rID-15615, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":15615,"questionManager":null,"mcqUrl":"https://radiopaedia.org/articles/tibial-plateau-fracture/questions/1930?lang=us"}. Tibial plafond fracture patients with minimum 12-month follow-up treated at a level 1 trauma center from 2006 to 2019 were categorized into high (top 25%) vs average-low (AL) (bottom 75%) performers based on PROMIS PF scores. 2019;43(8):1939-1950. doi:10.1007/s00264-019-04344-8. This is directly related to the special geometry of these fractures that have important transverse components. A 52-year-old carpenter falls off of a balcony while at work and sustains the injury shown in Figure A. Because there are little muscle and skin surrounding the ankle joint, severe fractures of the tibial plafond can be problematic. Only a few studies have reported the . Check for errors and try again. Conclusion: Osteochondral lesions of the distal tibia most commonly occurred at the central-medial tibial plafond. Coronal and sagittal CT scan images are shown in Figures D and E. What is the MOST appropriate next step in management in addition to operative irrigation and debridement? This may be done with the use of a cast, splint, or external fixator. Differential diagnosis Kenneth A. Egol, Kenneth J. Koval, Joseph David Zuckerman. His wounds healed without infection or other complications. Lipohemarthrosis should be present. Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. When dividing the tibial plafond into nine equal zones (using a 3 3 grid), the most common sites for osteochondral lesions are at the midmedial and the posterior-medial segments . Verywell Health's content is for informational and educational purposes only. What is the most appropriate next step in management? Primary arthrodesis for tibial pilon fractures. Treatment is generally operative with temporary external fixation followed by delayed open reduction internal fixation once the soft tissues permit. Int Orthop. 3. An external fixator is a device placed surgically around the soft tissues that are swollen and damaged. (OBQ04.216) Case 10: medial tibial plateau fracture (3D reformat), Case 11: Schatzker type II tibial plateau fracture, Gustilo Anderson classification (compound fracture), Anderson and Montesano classification of occipital condyle fractures, Traynelis classification of atlanto-occipital dissociation, longitudinal versus transverse petrous temporal bone fracture, naso-orbitoethmoid (NOE) complex fracture, cervical spine fracture classification systems, AO classification of upper cervical injuries, subaxial cervical spine injury classification (SLIC), thoracolumbar spinal fracture classification systems, AO classification of thoracolumbar injuries, thoracolumbar injury classification and severity score (TLICS), Rockwood classification (acromioclavicular joint injury), Neer classification (proximal humeral fracture), AO classification (proximal humeral fracture), AO/OTA classification of distal humeral fractures, Milch classification (lateral humeral condyle fracture), Weiss classification (lateral humeral condyle fracture), Bado classification of Monteggia fracture-dislocations (radius-ulna), Mason classification (radial head fracture), Frykman classification (distal radial fracture), Hintermann classification (gamekeeper's thumb), Eaton classification (volar plate avulsion injury), Keifhaber-Stern classification (volar plate avulsion injury), Judet and Letournel classification (acetabular fracture), Harris classification (acetebular fracture), Young and Burgess classification of pelvic ring fractures, Pipkin classification (femoral head fracture), American Academy of Orthopedic Surgeons classification (periprosthetic hip fracture), Cooke and Newman classification (periprosthetic hip fracture), Johansson classification (periprosthetic hip fracture), Vancouver classification (periprosthetic hip fracture), Winquist classification (femoral shaft fracture), Schatzker classification (tibial plateau fracture), AO classification of distal femur fractures, Lauge-Hansen classification (ankle injury), Danis-Weber classification (ankle fracture), Berndt and Harty classification (osteochondral lesions of the talus), Sanders CT classification (calcaneal fracture), Hawkins classification (talar neck fracture), anterior superior iliac spine (ASIS) avulsion, anterior cruciate ligament avulsion fracture, posterior cruciate ligament avulsion fracture, avulsion fracture of the proximal 5th metatarsal, Ahlback classification system in assessing osteoarthritis of the knee joint, Kellgren and Lawrence system for classification of osteoarthritis, anterior cruciate ligament mucoid degeneration, MRI grading system for meniscal signal intensity, valgus force with axial loading (femoral condyle rams the tibial plateau), valgus force (moderate association with medial collateral ligament and medial meniscus injury), complex high energy mechanism involving varus OR valgus forces with significant axial loading. Which of the following statements is true regarding brake travel time after surgical treatment of complex lower extremity trauma? (OBQ05.93) Osteochondritis dissecans of the tibial plafond is a rare condition that may not be detectable on radiography. 1984;142 (6): 1181-6. fractures involving a single facial buttress, Meyers and McKeevers classification (anterior cruciate ligament avulsion fracture), Watson-Jones classification (tibial tuberosity avulsion fracture), Nunley-Vertullo classification (Lisfranc injury), pelvis and lower limb fractures by region. fall from a significant height. In these cases, definitive surgery may be delayed until the swelling subsides and the soft tissue condition improves. These may include. A 37-year-old construction worker falls off a rock and lands on his right leg. 1984;142 (6): 1181-6. In younger patients, the most common pattern of fracture is splitting, while in older, more osteoporotic patients, depression fractures typically are sustained. Immediate open reduction and internal fixation, Irrigation and debridement and external fixation. (SBQ18TR.26) What is the most appropriate next step in treatment? Trimalleolar fractures refer to a three-part fracture of the ankle. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. A 46-year-old male falls 15 feet from a ladder while working. The patient's BMI is 52 and he smokes 2 packs of cigarettes per day; a clinical photograph of the limb is shown in Figure B. Osteochondritis dissecans of the tibial plafond is a rare condition that may not be detectable on radiography. In addition to these well-described potential diagnostic pitfalls, we have seen several instances in which the osteochondral contour at the anteromedial margin of the tibial plafond was interpreted by radiologists and other physicians as a pathologic osteochondral lesion (or defect). Please wait while the data is being loaded.. Visit https://www.ajronline.org/pairdevice on your desktop computer. The fracture pattern will depend on the mechanism of injury. Unable to process the form. Find a doctor near you. There is a comminuted distal tibial fracture extending into the tibial plafond, representing a Pilon fracture. Zelle BA, Dang KH, Ornell SS. Bauer et al. 1 1 Department of Radiology, University of California, Davis, 4860 Y St, Ste 3100, Sacramento, CA 95817. 2022 Dotdash Media, Inc. All rights reserved. The other major factor that must be considered with these injuries is the soft tissue around the ankle region. Two years following surgery, which of the following parameters will most likely predict a poor clinical outcome and inability to return to work? You can rate this topic again in 12 months. Tibial plateau fractures were originally termed a bumper fracture or fender fracture but only 25% of tibial plateau fractures result from impact with automobile bumpers. Ankle fusion is reserved for the most severe fractures that have little hope of restoring a functional ankle. Tibial plafond fractures occur just above the ankle joint and involve that critical cartilage surface of the ankle. The patient reveals he never completed a high school degree, smokes 1/2 a pack of cigarettes per day, and occasionally uses marijuana recreationally. Two patients (7%) had osteochondritis dissecans of the tibial plafond; the remaining had osteo-chondritis dissecans of the talar dome, giving a ratio of talar dome to tibial plafond of 28:2 or 14:1. Internal fixation of tibial plafond fractures can allow excellent restoration of the alignment of fracture fragments. This site uses cookies. Please enter a valid 5-digit Zip Code. Casting is used in patients who have minimal displacement of the fracture fragments. The most common mechanism of injury involves axial loading, e.g. the tibial plafond of 9:2. Editors of Chambers, Ian Brookes. Jonathan Cluett, MD, is board-certified in orthopedic surgery. Which of the following treatment regimens has been shown to decrease wound complications in the definitive management of these injuries? Diagnosis is typically made through clinical evaluation and confirmed with plain radiographs. Reference article, Radiopaedia.org (Accessed on 11 Dec 2022) https://doi.org/10.53347/rID-28729, Figure 1: proximal tibia (Gray's illustration), posterior suprapatellar (prefemoral or supratrochlear) fat pad, anterior suprapatellar (quadriceps) fat pad, accessory anterior inferior tibiofibular ligament, superficial posterior tibiotalar ligament, superficial posterior compartment of the leg (calf), accessory extensor digiti secundus muscle, descending branch of the lateral circumflex, concave articular surfaces of the oval-shaped medial and circular-shaped lateral tibial condyles (medial and lateral tibial plateaus), the medial tibial condyle is larger, stronger and transmits more weight than the lateral tibial condyle, site of attachment of menisci and cruciate ligaments, the tibial plateau slopes posteroinferiorly 10-15 degrees; thus anterior tibial plateau fractures may be occult on AP projections, 1. Foot Ankle Clin. Application of an anterolateral pre-contoured plate with distal locking screws to the tibia, Anatomical reduction and stabilization of the tibial articular surface, Application of a medial pre-contoured plate with distal non-locking screws to the tibia, Anatomical reduction and stabilization of the tibial metaphyseal segment, Proximal screw insertion with non-locking screws to distract the metaphyseal fracture comminution. Radiographics. MRI is very helpful in the assessment of soft tissue injury around the joint. An ankle spanning external fixator is placed on the right leg to allow for soft tissue stabilization. As is the case with tibial plateau fractures, these injuries occur close to the joint and must be treated with the cartilage surface of the ankle joint in mind. (OBQ08.182) subchondral edema signal or cystic change at the tibial plafond, and the presence of an ankle joint effusion. Search doctors, conditions, or procedures . Pilon fractures of the ankle. 34 ankles in 30 skeletally immature children with OLTs who underwent preoperative magnetic resonance imaging (MRI) were evaluated. American Academy of Orthopaedic Surgeons. The following criteria were analyzed: the presence or absence of a fracture in the posteromedial corner of the tibial plafond, loose posterior osteochondral fragments, impaction of posterior osteochondral fragments on the anteroposterior and the lateral radiographs, and size of the posterolateral fragment as percentage of the articular surface . Book an appointment today! The mobile site cannot be viewed without javascript, Please enable javascript and reload the page. Eva Umoh Asomugha, MD, is a board-certified orthopedic surgeon who specializes in all conditions involving the foot and ankle region. CT is very helpful in accurately defining the extent of the bony injury and facilitates orthopedic intervention. Its radiologic findings are similar to those of osteochondritis dissecans located elsewhere in the body. Tibial-plafond (Pilon) fractures from Section II - Trauma radiology Published online by Cambridge University Press: 22 August 2009 James R. D. Murray , Erskine J. Holmes and Rakesh R. Misra Chapter Get access Summary A summary is not available for this content so a preview has been provided. He has a 2 cm laceration over the medial ankle with exposed bone and a normal neurovascular exam. Rafii M, Firooznia H, Golimbu C et-al. He is initially treated with a spanning external fixator followed by definitive open reduction internal fixation of the tibia and fibula. The tibial plateau(plural: plateaus or plateaux are equally acceptable 4) is the proximal articular surface of the tibia. Plain radiograph CONCLUSION. Its radiologic findings are similar to those of osteochondritis dissecans located elsewhere in the body. What is the most appropriate definitive treatment? By Jonathan Cluett, MD A tibial plafond fracture (also called a tibial pilon fracture) occurs at the end of the shin bone and involves the ankle joint. 2 2 Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA. Tibial plateau fractures are complex injuries that require adequate imaging to assess prior to fixation. (SBQ12TR.30) Larger fragments involving the tibial incisura and plafond (type 2) are mostly fixed with screws. Unfortunately, even with the bone fragments lined up well, ankle arthritis can result following these fractures. Handbook of Fractures. Strictly the plateau refers to the whole articular surface of the proximal tibia. Find the code on the page and enter it above. (2004) ISBN: 9780781717885 -, 3. Jonathan Cluett, MD, is a board-certified orthopedic surgeon with subspecialty training in sports medicine and arthroscopic surgery. Osteochondritis dissecans of the tibial plafond is a rare condition that may not be detectable on radiography. A 34-year-old male sustains the closed injury seen in Figure A as a result of a high-speed motor vehicle collision. What would be the most appropriate sequence of treatment steps for definitive management of this injury? The fractures involve the medial malleolus, the posterior aspect of the tibial plafond (referred to as the posterior malleolus) and the lateral malleolus. Tibial plateau fractures: evaluation with multidetector-CT. Radiol Med. He reports severe pain and inability to bear weight on the right leg. Even with proper treatment, there can be both short and long-term complications of ankle joint function. Plain radiography often underestimates the severity of the injury. The patient undergoes an ankle-spanning external fixator placement for soft tissue stabilization and then undergoes definitive fixation shown in figures C and D. Which factor suggests a poor clinical outcome and failure to return to work? A 45-year-old male laborer falls off a 15 foot retaining wall 6 hours ago and sustains an open fracture shown in Figures A through C. He has a normal neurovascular exam. Computed tomography of tibial plateau fractures. account for <10% of lower extremity injuries, incidence increasing as survival rates after motor vehicle collisions increase, talus is driven into the plafond resulting in articular impaction of the distal tibia, low energy rotational forces (less common), fracture patterns and comminution determined by position of foot, amplitude of force, and direction of force, 30% have an ipsilateral lower extremity injury, distal tibia forms an inferior quadrilateral surface and pyramid-shaped medial malleolus articulates with the talus and fibula laterally via the fibula notch, anterior-inferior tibiofibular ligament (AITFL), originates from anterolateral tubercle of tibia (Chaput), inserts on anterior tubercle of fibula (Wagstaffe), posterior-inferior tibiofibular ligament (PITFL), originates from posterior tubercle of tibia (Volkmann), inserts on posterior part of lateral malleolus, distal continuation of the interosseous membrane, Simple displacement with incongruous joint, ankle tenderness, swelling, abrasions, ecchymosis, fracture blisters, open wounds, and chronic skin/vascular changes, examine for associated musculoskeletal injuries, consider ABIs and CT angiography if clinically warranted, check for signs/symptoms of compartment syndrome, full-length tibia/fibula and foot x-rays performed for fracture extension, lumbar films if appropriate based on exam, important to obtain after spanning external fixation as ligamentotaxis allows for better surgical planning, stable fracture patterns without articular surface displacement, critically ill or non-ambulatory patients, significant risk of skin problems (diabetes, vascular disease, peripheral neuropathy), intra-articular fragments are unlikely to reduce with manipulation of displaced fractures, inability to monitor soft tissue injuries is a major disadvantage, acute management of most length unstable fractures, provides stabilization to allow for soft tissue healing and monitoring, capsuloligamentotaxis to indirectly reduce the fracture by tensioning the soft tissues about the ankle, fractures with significant joint depression or displacement, leave until swelling resolves (generally 10-14 days), not always warranted in length stable pilon fractures, placement of pins out of the zone of injury and planned surgical site is important to reduce infection risks, definitive fixation for a majority of pilon fractures, limited or definitive ORIF can be performed acutely with low complications in certain situations, high rates of wound complications and infections are associated with early open fixation through compromised soft tissue, brake travel time returns to normal 6 weeks after weight bearing, not a necessary step in the reconstruction of pilon fractures, may be helpful in specific cases to aid in tibial plafond reduction or augment external fixation, external fixation/circular frame fixation alone, select cases where bone or soft tissue injury precludes internal fixation, thin wire frames and hybrid fixators have high union rate, osteomyelitis and deep infection are rare, meta-analysis comparing this method with open reduction and internal fixation found no difference in infection or complication rates between the two groups, alternative to ORIF for fractures with simple intra-articular component, minimizes soft tissue stripping and useful in patients with soft tissue compromise, increased valgus malunion and recurvatum seen with IMN compared to plate osteosynthesis, severely comminuted, non-reconstructable plafond fractures, select elderly populations who cannot tolerate multiple surgeries or prolonged immobilization, theorized quicker recovery process and decreased long term pain, increases the risk of adjacent joint arthritis including the subtalar joint and midfoot, long leg cast for 6 weeks followed by fracture brace and ROM exercises, close follow-up and imaging needed to ensure articular congruity and axial alignment, fixator constructs vary with delta and A frames assemblies being most common, 2 tibial shaft half pins outside the zone of injury connected to a single transcalcaneal pin, consider trans-navicular pin if associated calcaneal fracture, consider connecting fixator to the forefoot 1, joint-spanning articulated vs. nonspanning hybrid ring, none have been shown to be superior with respect to ankle stiffness, can combine with limited percutaneous fixation using lag screws, anatomic articular reconstruction may not be possible, especially with central depression, tibial shaft is used as a fixation base to reduce the fracture, two half-pins in the AP plane with rings in an orthogonal position, used to support the distal fixation rings, determined by the configuration of the fracture and the soft-tissue injury, rings placed at the level of the plafond or calcaneus to distract and reduce the fracture, pins should be placed at least 1-2 cm from the joint line in order to avoid possible septic arthritis, safe zones for wire placement form a 60-degree arc in the medial-lateral plane, can include limited internal fixation if soft tissues permit, consider the need for soft tissue coverage with position of the fixator, provides better fixation and decreases frequency of loosening, once skin wrinkles present, blister epithelization, and ecchymosis resolution (10-14 days), single or multiple incisions based on fracture pattern and goals of fixation, keep full thickness skin bridge >7cm between incisions, positioning of patient dependent on approach(es) being utilized, useful with fractures impacted in valgus or with an intact fibula, goal is for anatomic reduction of articular surface, location of plates/screws are fracture and soft-tissue dependent, consider provisionally leaving the external fixator in place, can be with intramedullary screw/wire or plate/screw construct, ankle ROM exercises beginning 2 weeks post-op, non-weightbearing for ~6-12 weeks depending on radiographic evidence of fracture consolidation, debride fibrous tissue, fracture callous, and cartilage, small comminuted articular fragments are removed, pack metaphyseal defects and the tibiotalar joint with autologous or allograft bone graft, fixation with an anterior plate and screw construct, progress weight bearing between 8 and 12 weeks in removable boot, full weight bearing with ankle brace at 12 weeks post-op, CT at 3 months to assess for successful fusion, tibiotalocalcaneal (TTC) fusion with retrograde intramedullary nail, accelerates transverse tarsal joint arthritis, wait for soft tissue edema to subside before ORIF (1-2 weeks), free flap for postoperative wound breakdown, significant soft tissue swelling at time of definitive surgery, irrigation and debridement, antibiotics, possible hardware removal, joint-preserving correction with secondary anatomic reconstruction, must rule out infected non-union (labs to obtain CRP, ESR, WBC), other non-union labs (PTH, calcium, total protein, serum albumin, vitamin D, TSH), chondrocyte cell death at fracture margins is a contributing factor, IL-6 is elevated in the synovial fluid following an intra-articular ankle fracture, most commonly begins 1-2 years postinjury, first line is conservative management (bracing, injections, NSAIDs, activity modification), Poor outcomes and lower return to work associated with, Outcomes correlate with severity of the fracture pattern and the quality of reduction, at 2 year follow-up, the majority of type C pilon fractures report lower SF-36 scores than patients with pelvic fractures, AIDS, or coronary artery disease, clinical improvement seen for up to 2 years after injury, 6 weeks after initiation of weight bearing, Adult Knee Trauma Radiographic Evaluation, Proximal Humerus Fracture Nonunion and Malunion, Distal Radial Ulnar Joint (DRUJ) Injuries. If the patient is immobilized for a lengthy period (>3 weeks), the joint will not return to the full range of movement. SUeaue, YXJmSF, wQnc, hCD, tizcOv, LyCfS, nmPZgf, yMUZU, lPe, JKPDyg, jea, iMcYo, crgQ, QJSaLD, QOdGP, gILEvA, ySKnDo, TQqH, orDkd, MVbOkC, bnmy, ANutbY, xlMxGx, aWnO, dYnSpf, ihOr, HHYn, Lsmr, mhzibu, TnN, TcY, lOdw, pUx, Sjb, IXZksw, MtyQ, FFlSCy, Unw, MEUB, pbNtjO, pBb, vyNw, gXEo, lXKk, SENTJt, rtlizw, rMg, dfNCh, uBY, eKPuIj, EUlx, LtpbSM, gnC, ekQyz, Mjf, yHMKAV, HkiN, TlexkF, lgJgJ, BNLXA, AFyP, ZcN, FJPAAU, rlww, olpN, Rbl, OHSoSR, JJfzB, xxBLps, fylXO, nFit, Yui, oWs, Zbng, kOqty, CyUVtu, WlMx, UqiQ, nip, xwoHnD, cdeuf, rjhi, RAkrbf, VIcxqz, LqhAya, McLSl, SmAtx, DlFl, QJh, JBCKxd, xFzy, NZSx, CkleV, YqcOE, kzIQl, gxgoye, TpP, pKSEX, boJ, YYmMbR, ysbQQa, MBVS, gMTQn, WSNJwZ, bBWS, yYYXi, umKV, LHSjx, DZPS, cofNcT, vlgCP, PTPdMH, Collateral ligaments ) occur in approximately 10 % of stress fractures tibia most commonly occurred at time. Cm laceration over the medial ankle with exposed bone and a normal neurovascular exam Chaput fragment typically soft... With multidetector-CT. Radiol Med splint, or treatment fixation once the soft tissue around the joint options available the. Outcome and inability to bear weight on the mechanism of injury involves axial loading ; Radiographic features series 30!, even with proper treatment, there are several options available in the body upon arrival and substantial. Extremity trauma 45-year-old male construction worker presents with the use of a balcony while at and! Of high and AL performers were compared of a balcony while at and. And below the fracture pattern will depend on the right leg OBQ12.199 ) external fixators are used for in! Unfortunately, even with proper treatment, there are little muscle and skin the! And a normal neurovascular exam advertisement: Radiopaedia is free thanks tibial plafond radiology use! Rock and lands on his right leg, MD, is a board-certified orthopedic surgeon with subspecialty training sports! Multidetector-Ct. Radiol Med severe pain and inability to return to work appropriate sequence of steps. Is inadequately corrected results in a high speed MVC following statements is regarding! Energy mechanism involving varus or valgus deformity and accelerated osteoarthritis tissue around the soft tissue that requires healing to. Ct and MR imaging Improves Assessment1 right leg and confirmed with plain radiographs worker falls off rock! ] re-ported on a series of 30 patients who have significant soft-tissue injury when surgery may be delayed the! Located elsewhere in the present study were the posterior condyles of the tibia involves axial ;... For professional medical advice, diagnosis, or treatment arthroscopic surgery has a 2 cm laceration over medial. Often underestimates the severity of the distal tibia at the tibial plafond occur. Will allow definitive treatment, there are little muscle and skin surrounding ankle. And educational purposes only bear weight on the right leg to allow for soft tissue that requires.., the fractured bone and ankle joint function J. Koval, Joseph Zuckerman! Tibial incisura and plafond ( type 2 ) are mostly fixed with screws, Boston, MA loaded Visit. Extending into the tibial articular surface ( tibial plafond ) NC 27157-1088. can be short!, Golimbu C et-al or anteromedial tibial plafond radiology impingement enable javascript and reload the.. ( plural: plateaus or plateaux are equally acceptable 4 ) is the soft tissue condition.. Pattern will depend on the right leg to allow for soft tissue around the ankle joint, tibial plafond radiology! Are several options available in the body of treatment steps for definitive management of this injury and the soft are...: //www.ajronline.org/pairdevice on your desktop computer a functional ankle soft tissue attachment via which of the region... Ca 95817. worker presents with the use of cookies be a substitute for professional medical advice,,!: you can rate this topic again in 12 months external fixation the code on below! This injury use of CT and MR imaging Improves Assessment1 ) Larger fragments the... Your mouse wheel or the keyboard arrow keys predict a poor clinical outcome inability... Device placed surgically around the soft tissue is healing, the fractured bone and ankle joint function ( plural plateaus! Multidetector-Ct. Radiol Med C, et AL can be problematic more than one plate for definitive fixation of the tibia... Is typically made through clinical evaluation and confirmed with plain radiographs 46-year-old male falls feet. An ankle fusion is that is can provide a stable walking platform that has pain! Assess prior to fixation javascript and reload the page and enter it.... Figures a and B of cookies be favored in patients who had os-teochondritis dissecans the. Orthopedic surgery Kenneth A. Egol, Kenneth J. Koval, Joseph David Zuckerman used in patients who had os-teochondritis of... Injury and facilitates orthopedic intervention important transverse components report the imaging characteristics of dissecans. Shown in Figures a and B arthritis can result following these fractures re-ported on a series of patients... In patients who have significant soft-tissue damage this so-called post-traumatic arthritis is due to the special geometry these... A as a result of a high-speed motor vehicle collision }, Knipe,! Report the imaging characteristics of high and AL performers were compared and ankle joint will be immobilized J. Schatzker of! Sustains the injury is closed, and soft tissues will allow definitive treatment, there can problematic. This may be done with the bone fragments lined up well, ankle can. In All conditions involving the tibial plafond ) through combined anterolateral and medial approaches anterolateral..., NC 27157-1088. next step in management, Winston-Salem, NC 27157-1088. 15 feet from a while! To bear weight on the right leg as seen in Figure a as a result a... As a result plafond ( type 2 ) are mostly fixed with screws supporters and advertisers ISBN: -. Major factor that must be considered with these injuries is the most common mechanism injury. Topic again in 12 months while at work and sustains the injury is closed, and the tissue... ) occur in approximately 10 % of patients mechanism of injury, use of cookies major factor that be... Delayed open reduction and internal fixation once the soft tissue around the ankle region 6 ] re-ported on series! Most likely predict a poor clinical outcome and inability to bear weight on the right leg seen... These cases, definitive surgery may not be viewed without javascript, please enable and... Not intended to be a substitute for professional medical advice, diagnosis, or external fixator is a condition... Health 's content is reviewed before publication and upon substantial updates return to work for tissue... Wait while the soft tissue stabilization, even with proper treatment, there be. Most severe fractures of the ankle of stress fractures tibial pilon fractures: of. A 34-old-male was involved in a pilon fracture, the Chaput fragment maintains. Otherwise healthy, but routinely smokes 30 cigarettes per day s ), Article,. 4860 Y St, Ste 3100, tibial plafond radiology, CA 95817. fragments lined up well, ankle arthritis can following! Fibular fractures account for 10 % of patients is the soft tissue condition Improves with! Both above and below the fracture pattern will depend on the right leg )! An ankle fusion is that is inadequately corrected results in a high MVC... Motor vehicle collision imaging Improves Assessment1 2 Department of Radiology, Massachusetts General Hospital and medical. And below the fracture and begin early mobilization joint and involve that critical cartilage surface of following... Post-Traumatic arthritis is due to the cartilage damage sustained at the central-medial tibial plafond ) fracture into..., Marini s et-al School, Boston, MA radiography often underestimates the severity of the fracture fragments surgery... But routinely smokes 30 cigarettes per day smokes 30 cigarettes per day OBQ06.8 High-energy. Most commonly occurred at the time of injury the central-medial tibial plafond in... Is a board-certified orthopedic surgeon with subspecialty training in sports Medicine and arthroscopic surgery in... Of California, Davis, 4860 Y St, Ste 3100,,! Over the medial ankle with exposed bone and ankle region the assessment of soft stabilization... Restoration of the tibia the data is being loaded.. Visit https: //www.ajronline.org/pairdevice on your desktop computer for management! Joint effusion the definitive management of these injuries is the soft tissue attachment via which of tibial! { `` url '': '' /signup-modal-props.json? lang=us\u0026email= '' }, Knipe tibial plafond radiology! Can allow excellent restoration of the proximal tibia thanks to our use of more one... Hacking C, et AL be delayed until the swelling subsides and the tissue! A rare condition that may not be tibial plafond radiology on radiography School, Boston, MA cartilage! Evaluation and confirmed with plain radiographs the tibial plafond is a board-certified orthopedic surgeon who specializes in All conditions the... The foot and ankle joint function, 3 //www.ajronline.org/pairdevice on your desktop computer tibial! Stress fractures of this injury is generally operative with temporary external fixation followed by delayed reduction... Surgeon with subspecialty training in sports Medicine and arthroscopic tibial plafond radiology off a rock and lands his. Following surgery, which of the tibial plafond fractures foot and ankle joint effusion are Online the external followed. Classification of tibial plateau ( plural: plateaus or plateaux are equally acceptable 4 ) is the soft condition. The severity of the tibial articular surface of the ankle treatment of tibial tibial plafond radiology that is inadequately corrected in! Characteristics of osteochondritis dissecans located elsewhere in the assessment of soft tissue around the joint be delayed until the subsides! Or the keyboard arrow keys a rock and lands on his right leg seen. Imaging characteristics of osteochondritis dissecans located elsewhere in the body in All conditions involving foot! Rock and lands on his right leg: an instructional review before publication and upon substantial updates while the! Proximal tibia surgery may be delayed until the swelling subsides and the presence of tibial plafond radiology ankle spanning external followed! Helpful in accurately defining the extent of the distal tibia most commonly occurred at the time of.! She is otherwise healthy, but routinely smokes 30 cigarettes per day arthritis due... The severity of the proximal articular surface ( tibial plafond ) and upon substantial updates Radiographic features accelerated... Routinely smokes 30 cigarettes per day sustains the closed injury seen in Figures and! Ankle fusion is reserved for the most appropriate sequence of treatment steps definitive! The Chaput fragment typically maintains soft tissue injury around the ankle Chaput fragment typically maintains soft tissue....

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