What is Tibial Plafond Fracture?
A Tibial Plafond Fracture is an rare fracture happen in the distal neighborhood of the shinbone . It is also jazz as Pilon crack and explosion fracture . It involves the articulary surface of the ankle joint . The cause of Tibial Plafond Fracture is axial or rotational force play occurring from motor vehicle accidents or falling from a height . Any case of forceful impact to tibia , which causes significant damage to the mild tissue and bone , can leave in a Tibial Plafond Fracture . Tibial Plafond Fractures imply a large area of Tibia ’s system of weights birth part in the ankle joint joint due to which it is difficult to rectify or fix this type of fracture and because of the difficulty incurred in fixing Tibial Plafond Fractures , they are often associated with poor termination and higher rate of complicatedness .
Anatomy of Tibial Plafond
Plafond is the name of the distal part of the tibia . Plafond together with the lateral and medial malleoli organize the mortise , which articulate with the talar noodle . The plafond is convex in the sidelong plane and concave in the anteroposterior airplane . In the anterior plane , it is encompassing , so that it can provide more stability , especially during the process of free weight - bearing . The tibiofibular ligament , the firm deltoid ligament and the interosseous ligament provide backing to the distal shin bone .
Classification of Tibial Plafond Fracture
Tscherne Classification of Tibial Plafond Fracture
Grade 0 Tibial Plafond Fracture : – In this stage , there is minimal damage to the soft tissue paper with collateral injury to the limb . The pattern of the fracture is simple .
Grade 1 Tibial Plafond Fracture : – There is superficial contusion or abrasion to the bone and the form of the fracture is also mild .
Grade 2 Tibial Plafond Fracture : – There is cryptical excoriation with contusion to the hide or heftiness . The pattern of the shift is serious . There is lineal injury to the tree branch .
Grade 3 Tibial Plafond Fracture : – There is austere bruise to the skin or crush injury with extensive damage to the underlie muscle . Patient also has subcutaneous avulsion with compartment syndrome .
Ruedi and Allgower Classification of Tibial Plafond Fracture
case A : There is very mild or no articular displacement .
Type B : There is displacement of the articulary surface with absence of comminution .
character coulomb : There is intra - articulary displacement with pronounced impaction / comminution .
Signs & Symptoms of Tibial Plafond Fracture
Physical Exam for Tibial Plafond Fracture
Soft tissue integrity : During strong-arm exam , the diffuse tissue paper unity is examined . The patient ’s ankle joint is also control for abrasions , swelling , fracture blisters , ecchymosis and open wounds .
Other injuries : Checkup is also done to expect for other associated musculoskeletal injury . The knee joint is evaluated for any harm to the soft tissue or any bony disruption .
Alignment and Stability : The stability and range of motion of the ankle joint is examined . The alignment of the ankle joint is assessed .
Neurovascular Exam : The dorsalis pedis and posterior tibial pulses and capillary refill are checked . The doctor also looks for any neurological compromise . The patient is also checked for any signs of compartment syndrome . Patient ’s sensation in the ankle and the power to move his / her toe is also assessed .
Diagnosis of Tibial Plafond Fracture
skiagraph : Radiographs , such as x - rays of the understructure , tibia , mortise joint and articulatio genus are take up . Traction radiographs are taken in both the sidelong and anteroposterior planes . Contralateral ankle radiographs are also beneficial in diagnosing . commend views in radiographs of ankle include anteroposterior , sidelong and mortise views . XTC - rays of the foot with full - distance of tibia and fibula should be lease to reckon for fracture extension .
CT Scans : CT scans are also important and are postulate in many case . CT scan helps in delineating the articular involvement . CT scan also helps in planning of the surgery .
Treatment for Tibial Plafond Fracture
The aim of treatment for Tibial Plafond Fracture is stable fixation of the metaphysis to the shaft and reestablishment of articular congruity in a satisfactory alignment . Treatment for Tibial Plafond Fracture is also done with the view of prevent complication as much as possible .
Non-Operative Treatment for Tibial Plafond Fracture
immobilisation of the ankle joint is done where there is stable fracture pattern without displacement of the articular open . This method of intervention is also adopt in patient who are nonambulatory and who are critically ill . There is substantial risk of skin trouble with immobilization , especially if the patient is suffer from vascular disease , diabetes and neuropathy .
farseeing pegleg cast of characters is placed for about six workweek after which a fracture brace is used . Range of movement exercises are also started under the guidance of a certified physical therapist .
The chances of simplification of intra - articular shard are less in manipulation of the force out break . release of diminution ordinarily happen and there is difficulty in monitor the combat injury to the sonant tissue .
Operative Treatment for Tibial Plafond Fracture
Temporizing external fixation is done across the ankle joint joint . This is done in acute cases and help in stabilizing the fractured bone along with helping in the healing of the soft tissue . patient who have faulting with substantial joint shift or depression benefit from this operation . This is leave until the swelling subsides , which take around 10 years to two weeks .
This surgical procedure is done in severe cases of bone fracture include the Tibial Plafond Fracture . It is a method of definitive regression in most of the cases of Tibial Plafond Fracture . Low complications are associated in sure situations with limited or classical ORIF .
External Fixation is done in prime font . Intramedullary nail fixation along with transdermic piece of ass fixation is done . international fixation can be done as an alternative to ORIF in certain cases .
