Postoperative Radiographic and Clinical Assessment of the Treatment of Posterior Tibial Plafond Fractures Using a Posterior Lateral Incisional Approach

Abstract

The purpose of the present study was to evaluate the postoperative radiographic and functional outcomes of reduction and fixation of a posterior plafond fracture using a posterolateral approach. We included 38 patients with a tibial plafond fracture. Fixation was most commonly performed using screws, T plates, or meta plates. The average follow-up period was 38 (range 25 to 72) months. The clinical outcomes of these patients were evaluated using the American Orthopaedic Foot Ankle Society score. The radiographs of the included patients were evaluated twice within 2 months by 3 experienced orthopedic trauma surgeons, who performed the retrospective radiographic review. Articular step off measures included the radiographic appearance of the reduction using picture archiving and communication system measurement tools. All 32 patients showed radiologic evidence of bony union at the follow-up visit; 6 patients were lost to follow-up. The American Orthopaedic Foot Ankle Society average score was 92 points; 21 patients (93.7%) had excellent scores (90 to 100 points), 9 patients (28.1%) had good scores (80 to 89 points), and 2 patients (6.2%) had fair scores (<80 points). Excellent to good outcomes were noted in 93.7% of the patients. One patient developed a superficial infection. Another patient experienced a sural cutaneous nerve injury. The radiographic articular step off was measured as 1 mm or less in 29 patients (90.6%) and 1 to 2 mm in 3 patients (9.4%). One patient (3.1%) developed symptomatic post-traumatic arthritis. The posterolateral approach allowed for good exposure and buttress fixation of the posterior plafond fractures with few local complications. The anatomic repositioning and stable fixation resulted in good functional and subjective outcomes.