![]() The soft tissues should be inspected carefully substantial swelling, soft tissue damage, and open injuries are common. Plain radiographs, obtained at the time of injury and after provisional reduction, and a CT scan after initial stabilization, are essential to fully understand the fracture and form an adequate preoperative plan. These characteristics underscore the importance of meticulous soft tissue management during fixation for optimal soft tissue and bony healing. The soft tissue envelope around the distal tibia is thin and constrained and the majority of the blood supply is supported by an anastamotic network of extraosseous vessels from the posterior tibial and anterior tibial arteries. Reduction of the articular surface after fracture is essential to decreasing the peak contact pressures realized in the joint and possibly decreasing the incidence of posttraumatic osteoarthritis. Common fracture fragments seen in plafond fractures are defined by these ligamentous attachments: for example, the posterolateral (Volkmann’s), anterolateral (Chaput), and medial fragments. The ankle is a ginglymus joint that is stabilized by strong ligamentous connections between the distal tibia and fibula, calcaneus, talus, and navicular. ( C) AP and ( D) lateral radiographs after open reduction and internal fixation with correction of limb alignment show near anatomic restoration of the articular surface. ( A) AP and ( B) lateral radiographs show a comminuted intraarticular pilon fracture with concurrent fibular fracture and valgus malalignment. The fibula, fractured in the majority of cases, is important in understanding the mechanism of injury and as a reference during surgical fixation to help determine correct limb length, alignment, and rotation. 1A) with the ankle position influencing the pattern of injury (eg, dorsiflexion tends to cause anterior injury) ( Fig. An axial load drives the talar dome into the distal tibia ( Fig. The plafond (or roof) is the distal articular and load-bearing surface of the tibia. Complications are common after fixation, and posttraumatic arthritis occurs in a high percentage of patients even with adequate restoration of the joint surface. Because of the often high energy involved and the limited soft tissue envelope that surrounds the distal tibia, these fractures require careful attention to the soft tissue envelope for timing and method of surgical fixation. This relatively rare injury (< 10% of lower extremity fractures) usually occurs in adults (aged 30s to 40s) owing to a fall from height or a motor vehicle crash. High-energy injuries, older age, and poor reduction quality are also related to worse clinical outcomes.Pilon fractures, or fractures of the tibial plafond, range from low- to high-energy axial-loading injuries. Increased initial fracture area is correlated with poor clinical functional results. 001 for each).Ĭonclusions: Preoperative fracture area measurement has a major effect on healing of tibia pilon fractures. Preoperative fracture area, measured on both the anteroposterior and the lateral views, are significantly related to both Ovadia-Beals Score and Maryland Foot Score ( P <. Age, injury mechanism, and reduction quality have a significant relationship with Maryland Foot Score ( P <. Results: With an average follow-up period of 29.2 months (range, 24–40 months), 34 patients (85%) had excellent or good results, whereas only two patients (5%) had poor clinical results. To evaluate the objective quantity of initial fracture crack width and displacement, a new parameter was defined: “fracture area.” All measurements were conducted using a feature from the picture archiving and communication system on anteroposterior and lateral radiographs taken separately in standard fashion. The demographic data of the patients, injury mechanisms, fracture type, reduction quality, clinical results, and postoperative complications were recorded. Methods: In this retrospective cohort study, 40 patients with Arbeitsgemeinschaft für Osteosynthesefragen and Orthopaedic Trauma Association type 43B and 43C tibia pilon fractures and operated on through the extensile anteromedial approach were analyzed. Our objective was to investigate the effect of initial fracture crack width and displacement degree on clinical functional results in tibia pilon fractures. Although many factors such as reduction quality and soft-tissue coverage have been identified, researchers continue to investigate the factors that affect healing in tibia pilon fractures. Background: Tibia pilon fractures are associated with high complication rates, decreased quality of life, and low patient satisfaction.
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