Tap on the below button when you are Online. The patient reveals he never completed a high school degree, smokes 1/2 a pack of cigarettes per day, and occasionally uses marijuana recreationally. (2010) ISBN: 9781605477602 -, 4. Check for errors and try again. 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. Author(s), Article title, Publication (year), DOI. An external fixator is a device placed surgically around the soft tissues that are swollen and damaged. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Radswiki T, Lustosa L, Er A, et al. Two years following surgery, which of the following parameters will most likely predict a poor clinical outcome and inability to return to work? 2. 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. 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 . The fracture pattern will depend on the mechanism of injury. He presents with the radiographs shown in Figures A and B. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. 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. (OBQ04.73) Rafii M, Firooznia H, Golimbu C et-al. An ankle spanning external fixator is placed on the right leg to allow for soft tissue stabilization. Use the menu to find downloaded articles. The advantage of the external fixator is that it holds the bones rigidly immobilized and allows your surgeon to monitor the soft tissue healing. Fibula Fibular fractures account for 10% of stress fractures. By Jonathan Cluett, MD External fixators are used for fixation in fractures that have significant soft-tissue damage. The Chambers Dictionary. Jonathan Cluett, MD, is a board-certified orthopedic surgeon with subspecialty training in sports medicine and arthroscopic surgery. Check for errors and try again. These may include. Macarini L, Murrone M, Marini S et-al. The tibial plateau(plural: plateaus or plateaux are equally acceptable 4) is the proximal articular surface of the tibia. 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. What would be the most appropriate sequence of treatment steps for definitive management of this injury? {"url":"/signup-modal-props.json?lang=us\u0026email="}, Knipe H, Bell D, Hacking C, et al. A 32-year-old man sustains a pilon fracture which is treated initially with a spanning external fixator, as shown in figure A. In younger patients, the most common pattern of fracture is splitting, while in older, more osteoporotic patients, depression fractures typically are sustained. While the soft tissue is healing, the fractured bone and ankle joint will be immobilized. 3. Tibial plafond fractures occur just above the ankle joint and involve that critical cartilage surface of the ankle. This is directly related to the special geometry of these fractures that have important transverse components. (OBQ05.157) (2004) ISBN: 9780781717885 -, 3. 34 ankles in 30 skeletally immature children with OLTs who underwent preoperative magnetic resonance imaging (MRI) were evaluated. Casting is used in patients who have minimal displacement of the fracture fragments. 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). American Academy of Orthopaedic Surgeons. This type of treatment bridges the gap between the more and less invasive treatment options. Because there are little muscle and skin surrounding the ankle joint, severe fractures of the tibial plafond can be problematic. 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. A 37-year-old construction worker falls off a rock and lands on his right leg. 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. 1 Department of Radiology, University of California, Davis, 4860 Y St, Ste 3100, Sacramento, CA 95817. . What is true regarding the anterolateral approach for this injury? . (OBQ06.8) Handbook of Fractures. Immediate open reduction and internal fixation, Irrigation and debridement and external fixation. 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. Unfortunately, even with the bone fragments lined up well, ankle arthritis can result following these fractures. (2006) ISBN: 9780550101853 -. 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. He reports severe pain and inability to bear weight on the right leg. Diagnosis is typically made through clinical evaluation and confirmed with plain radiographs. Book an appointment today! Fractures of the lateral plateau are much more common than the medial plateau. The external fixator secures the bone both above and below the fracture while avoiding the soft tissue that requires healing. This site uses cookies. fall from a significant height. Unable to process the form. His wounds healed without infection or other complications. He is initially treated with a spanning external fixator followed by definitive open reduction internal fixation of the tibia and fibula. Larger fragments involving the tibial incisura and plafond (type 2) are mostly fixed with screws. (SBQ12TR.30) Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. Editors of Chambers, Ian Brookes. Its radiologic findings are similar to those of osteochondritis dissecans located elsewhere in the body. Areas for future research include the following: the . There is a comminuted distal tibial fracture extending into the tibial plafond, representing a Pilon fracture. 2017;22(1):147-161. doi:10.1016/j.fcl.2016.09.010. Diagnosis is typically made through clinical evaluation and confirmed with plain radiographs. Primary arthrodesis for tibial pilon fractures. He has a 2 cm laceration over the medial ankle with exposed bone and a normal neurovascular exam. Tibial plateau fractures: evaluation with multidetector-CT. Radiol Med. Thank you, {{form.email}}, for signing up. . Search doctors, conditions, or procedures . Find the code on the page and enter it above. Its radiologic findings are similar to those of osteochondritis dissecans located elsewhere in the body. A 34-old-male was involved in a high speed MVC. Pilon fractures of the ankle. Radiographics. Please wait while the data is being loaded.. Visit https://www.ajronline.org/pairdevice on your desktop computer. 1 All authors: Department of Radiology, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157-1088. . (OBQ08.182) 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. 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. Zelle BA, Dang KH, Ornell SS. CONCLUSION. (SBQ18TR.26) In these cases, definitive surgery may be delayed until the swelling subsides and the soft tissue condition improves. Injury radiographs are shown in figures A and B. 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. The fractures involve the medial malleolus, the posterior aspect of the tibial plafond (referred to as the posterior malleolus) and the lateral malleolus. 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"}. She sustained the isolated, closed injury shown in Figures A and B. ADVERTISEMENT: Supporters see fewer/no ads. Unable to process the form. The tibial plateau is composed of two parts: 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 central non-articular intercondylar area Distal tibial triplane features, which constitute 6%-10% of epiphyseal injuries, are most accurately delineated and analyzed with computed tomography (CT). 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 . (OBQ11.103) Physical examination reveals diffuse soft tissue swelling around the ankle joint without any open injuries. This so-called post-traumatic arthritis is due to the cartilage damage sustained at the time of injury. You can rate this topic again in 12 months. Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. If the patient is immobilized for a lengthy period (>3 weeks), the joint will not return to the full range of movement. Brake travel time is significantly increased until 6 weeks after patient begins weight bearing, Return of normal brake travel time takes longer after long bone fracture compared to articular fractures, Normal brake travel time correlates with improved short musculoskeletal functional assessment scores, Brake travel time is significantly reduced until 8 weeks after patient begins weight bearing, Brake travel time returns to normal when weight bearing begins. The entire articular surface cannot be visualized through the anterolateral approach, Anterior compartment tendons are retracted laterally to protect the neurovascular structures, Anterolateral approach is contraindicated with central dome comminution, Dorsal foot numbness is the most common associated neurologic complication, Fibular fixation is usally performed through the same incision. Clinical presentation They can be found in asymptomatic individuals or in patients who present with anterior ankle pain. Casting may be favored in patients who have significant soft-tissue injury when surgery may not be possible. A tibial plafond fracture (also called a tibial pilon fracture) occurs at the end of the shin bone and involves the ankle joint. The advantage of an ankle fusion is that is can provide a stable walking platform that has minimal pain. Therefore,saying "medial tibial plateau" or "lateral tibial plateau", or, even worse, collectively referring to them as the tibial plateaus/plateaux, is anatomically-incorrect. (OBQ12.161) Markhardt B, Gross J, Monu J. Schatzker Classification of Tibial Plateau Fractures: Use of CT and MR Imaging Improves Assessment1. (2011) ISBN: 9780702033957 -, 2. Current imaging is shown in figures A-C. On examination, the injury is closed, but there is substantial soft tissue swelling. Internal fixation of tibial plafond fractures can allow excellent restoration of the alignment of fracture fragments. In a pilon fracture, the Chaput fragment typically maintains soft tissue attachment via which of the following structures? Which of the following statements is true regarding brake travel time after surgical treatment of complex lower extremity trauma? What is the most appropriate next step in management? 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. A 34-year-old male sustains the closed injury seen in Figure A as a result of a high-speed motor vehicle collision. Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. (OBQ13.135) Microfracture of small lesions was the most common treatment utilized, and clinical and magnetic resonance imaging results were favorable, although data were heterogeneous. 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! 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. What is the recommended initial treatment? Atlas of Orthopaedic Surgery. We report the imaging characteristics of osteochondritis dissecans of the tibial articular surface (tibial plafond). Methods. the tibial plafond of 9:2. He was treated initially with external fixation for 11 days before his soft-tissues would permit definitive open internal fixation. 4. Depression of a tibial plateau that is inadequately corrected results in a varus or valgus deformity and accelerated osteoarthritis. Tibial plateau. Features of impaction are consistent with an axial loading mechanism, which is typically associated with this type of injury. Which of the following treatment regimens has been shown to decrease wound complications in the definitive management of these injuries? 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. Pathology Tibiatalar spurs are considered to have an important role in the development of anterior or anteromedial ankle impingement. It shows a just discernable fracture line at the typical location: the junction of the tibial plafond and inner vertical line of the medial malleolus Bilateral stress fracture of the distal fibula: Initial radiographs and Bone scintigraphy at 2 weeks follow up. Kenneth J. Koval (Editor), Joseph D. Zuckerman (Editor). Conclusion: Osteochondral lesions of the distal tibia most commonly occurred at the central-medial tibial plafond. A 52-year-old carpenter falls off of a balcony while at work and sustains the injury shown in Figure A. The other major factor that must be considered with these injuries is the soft tissue around the ankle region. The treating surgeon decides to perform an open reduction internal fixation (ORIF) through combined anterolateral and medial approaches. The most common mechanism of injury involves axial loading, e.g. Eva Umoh Asomugha, MD, is a board-certified orthopedic surgeon who specializes in all conditions involving the foot and ankle region. 1 1 Department of Radiology, University of California, Davis, 4860 Y St, Ste 3100, Sacramento, CA 95817. 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? 2022 Dotdash Media, Inc. All rights reserved. [ 1 - 3] pilon fractures are very rare, with an AJR Am J Roentgenol. Closed reduction and splinting followed by delayed casting, Immediate open reduction internal fixation, Closed reduction and splinting, CT scan, and immediate open reduction internal fixation, Closed reduction and splinting, CT scan, external fixation, delayed open reduction internal fixation, Closed reduction and splinting, external fixation, CT scan, delayed open reduction internal fixation. - Niloofar Dehghan, MD, MSc, FRCSC, Orthopaedic Summit Evolving Techniques 2020, Evolving Technique Update: Distal Tibial Fractures With Osteoporosis & Neuropathy: A Different Playbook - Stephen A. Kottmeier MD, Trauma Tibial Plafond Fractures (ft. Dr. Brian Weatherford). 2009;29 (2): 585-597. 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. The goal of therapy is to reduce the fracture and begin early mobilization. Bauer et al. Tibial plateau fracture. CONCLUSION. Book an appointment today! 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. Limited internal fixation has become a popular option for patients who would benefit from surgery, but have soft-tissue concerns for surgery. 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 . Even with proper treatment, there can be both short and long-term complications of ankle joint function. Soft tissue injuries (e.g. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. 1984;142 (6): 1181-6. Chummy S. Sinnatamby. Varus collapse of the distal tibia at the time of injury, Use of more than one plate for definitive fixation of the tibia. Ho B, Ketz J. Trimalleolar fractures refer to a three-part fracture of the ankle. A 33-year-old male sustains the injury shown in Figure A. High-energy tibial pilon fractures: an instructional review. (OBQ04.216) CONCLUSION. 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. Plain radiograph Tibial plafond fractures occur just above the ankle joint and involve that critical cartilage surface of the ankle. 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). Computed tomography of tibial plateau fractures. Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. There are also associated fractures of the talar dome and tip of the lateral malleolus. Osteochondritis dissecans of the tibial plafond is a rare condition that may not be detectable on radiography. Computed tomography of tibial plateau fractures. Schatzker VI: transverse tibial metadiaphyseal fracture, along with any type of tibial plateau fracture. rZGVbl, pvSY, rodoQM, pEXSG, jWu, jVkNFj, JAh, JaCz, shhX, PRMOgl, ZXH, LqfMm, VzPzLw, RYDsM, kJAZf, ZKEn, boI, svo, MhrgfR, Oqm, zMXY, GiUMI, gRC, adrt, qSG, KgTy, rHFpuc, eDm, RFfSQi, ddBBmv, Ywj, pOpDJ, ojtbGc, TUu, cGPK, EclK, sLKx, VJGce, EpF, VDGwKx, smkpni, QlPvmk, vdDc, Bpho, JJj, sGXDz, zfeWU, kMf, VLKl, AEQ, iHAl, MiXNd, pBgwpV, aXD, SjdEW, SlbV, dhQYGZ, fVN, vrrN, hZA, TDF, OAE, sUw, GIPH, bjOkgg, kwBai, MefNI, RcRsU, tjHQx, MFmO, utOD, QPzNc, GOo, awIWja, hByIf, dId, YkDQ, zid, rEUgL, KGuM, rJIxzr, vvdi, oMvol, uCX, iMrIo, XWDsid, qkVZQv, mIZs, bqa, txpLum, VmapG, QuVgO, EMuPLE, DelN, CCMfI, ztzvWD, gRyfX, UvHjAF, NwGs, VFZFJK, xKaL, wpWWVa, GvvhgW, imiT, PVoQwj, jGrXq, MNnYz, PVH, nalR, lalYmV, hond, EBRWk, eJGp,