Introduction:

Tibial plafond fractures, also known as pilon fractures or tibial pylon fractures, refer to fractures that occur at the distal end of the tibia, affecting the weight-bearing surface of the ankle joint. These fractures are often associated with high-energy trauma and can be challenging to treat due to the complexity of the injury and the limited soft tissue coverage in this area. This article offers a comprehensive overview of tibial plafond fractures, discussing their etiology, classification, clinical presentation, diagnostic modalities, and management strategies.

Etiology and Mechanism of Injury:

High-Energy Trauma: Such as falls from a significant height or motor vehicle accidents.

Axial Loading: A forceful downward energy causing the talus to drive into the tibial plafond.

Rotational Forces: Can also contribute, especially in combination with axial loading.

Classification:

The Ruedi-Allgower classification is commonly used:

• Type I: Non-displaced fractures.
• Type II: Displaced fractures with no significant comminution.
• Type III: Highly comminuted fractures.

Clinical Presentation:

• Pain and Swelling: Severe pain at the ankle joint, accompanied by significant swelling.
• Deformity: Visible deformity in severe cases.
• Inability to Bear Weight: Due to pain and instability.
• Skin Compromise: Open fractures or impending compartment syndrome may be present.

Diagnostic Approaches:

Radiographs: Anteroposterior (AP), lateral, and oblique views of the ankle to assess the fracture pattern.

CT Scan: Provides detailed information about the fracture, especially in comminuted injuries, aiding surgical planning.

Management and Treatment Strategies:

Initial Management: Includes pain control, elevation of the limb, ice application, and immobilization.

Surgical Intervention: Most tibial plafond fractures require surgery for optimal outcomes. The timing and approach depend on the soft tissue condition.

• External Fixation: Used initially in cases with significant soft tissue injury.
• Open Reduction and Internal Fixation (ORIF): Performed once the soft tissue condition allows.

Physical Therapy: Rehabilitation is crucial post-surgery to regain range of motion and strength.

Weight-Bearing Restrictions: Non-weight-bearing or limited weight-bearing is advised for several weeks post-surgery.

Complications:

• Post-traumatic Arthritis: Due to cartilage damage at the time of injury.
• Infection: Especially in open fractures.
• Malunion or Nonunion: Improper or failed bone healing.
• Soft Tissue Complications: Such as wound healing problems or compartment syndrome.

Conclusion:

Tibial plafond fractures are complex injuries that demand a meticulous and staged approach to management. Early recognition, appropriate surgical intervention, and dedicated rehabilitation are vital to achieving favorable outcomes and restoring ankle function.

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