Non-reducible, open tibial plafond fractures treated with a circular external fixator (is the current classification sufficient for identifying fractures in this area?)

Abstract

While some researchers advocate primary arthrodesis for the treatment of open, severely comminuted tibial plafond fractures, others argue that an external fixator is an alternative. In this study, we obtained intermediate clinical and radiological outcomes on treating such fractures with a circular external fixator. Twelve patients with non-reducible, open tibial plafond fractures were treated with a circular external fixator and minimal osteo-synthesis. The fractures were grouped using a modification of the Ruedi and Allgower classification: eight, two, and two of the patients had Type III, IVA, and IVB fractures, respectively. The bone transport technique was applied in the patients with a Type IVB fracture. Four parameters were tracked in the patients: the reduction score of the joint surface, early complications, and the radiological and clinical findings of the ankle. The average follow-up period of the patients was 54.5 months. In the postoperative radiological examinations, the reduction score of the joint surface exceeded 15 in four patients and was 12-15 in eight patients. Type III and IVA fractures united with an average healing time of 4.25 months. Surface wound infection was observed in three patients. One patient each developed fibular osteomyelitis, claw toe, and 2cm shortness. Among the patients with Type IVB fractures, nonunion and malunion in the newly forming callus was observed in one patient, and nonunion alone was observed in another patient. On the final check, both the clinical and radiological findings were poor for all of the patients, with a reduction score exceeding 15. High-energy and poor joint surface reduction scores are two important factors affecting both the clinical and radiological results. For the fractures with reduction scores below 15, it is particularly difficult to predict the clinical results. Therefore, we recommend that such fractures be treated with a circular external fixator and believe that arthrodesis in accordance with the patient's choice is a desirable treatment method.