Management of Intra-Articular Tibial Plafond Fracture Using Ring Fixator

Abstract

Abstract Background Intraarticular fractures of the distal tibia is a challenging condition that requires surgical intervention in the majority of cases. Due to the nature of the injury and the vulnerable soft tissue envelope around the ankle and distal tibia, skin necrosis and soft tissue devitalization is a major concern. Open reduction and internal fixation offers a reliable method to restore the anatomy and to maintain the length of the limb, however, in many cases this approach might not be ideal and get complicated with skin sloughing and necrosis. Aim of the Work To evaluate the role of ring external fixator in the management of intra articular fractures of the tibial plafond and to assess the functional outcome and patient satisfaction following this procedure. Patients and Methods Ring External fixation with minimally invasive AO screws offer another reliable alternative that achieves the reduction and allows for soft tissue healing. In this study we prospectively treated 30 patients who presented with distal tibia intraarticular fractures using Ilizarov frames in combination of minimally invasive AO screws. The minimum follow up was 4 years and the outcome was assessed radiologically and functionally using AOFAS scores. Results The results showed that 96% of the patients achieved bony union and satisfactory functional scores. There was no incidence of skin or soft tissue necrosis apart from superficial pin tract infection that was treated successfully. Three patients developed ankle OA four years post operatively that was managed later with ankle fusion. One patient experienced non union and was managed with pantalar ankle fusion. The Mean AOFAS scores at 12 months and 48 months were 76.2±8 Range (59-89) and 75.1±11 Range (37-91) respectively. In addition, we found that smokers within the study group had significantly lower AOFAS scores than non-smokers. Conclusion Ilizarov external fixation with minimally invasive AO screws is considered a reliable and safe way to manage intraarticular fractures of the distal tibia that respects the soft tissues and produce good functional results.