Document Detail

The Reconstruction of Tibial Metaphyseal Comminution Using Hybrid Frames in Severe Tibial Plafond Fractures.
MedLine Citation:
PMID:  23449098     Owner:  NLM     Status:  Publisher    
OBJECTIVES:: To evaluate the treatment alternatives for the management of the metaphyseal tibial comminution in severe plafond fractures, and to investigate the role of the fibula fracture fixation. DESIGN:: Retrospective clinical study. SETTING:: Level-2 trauma hospital. PARTICIPANTS:: Patients with highly comminuted tibial plafond fractures. INTERVENTION:: All patients were treated with open reduction and internal fixation of the articular surface and external fixation of the metaphyseal fracture. If metaphyseal comminution was minimal, bone graft was applied and the fibular was plated (group 1); if comminution was between 1 and 3 cm, acute shortening and distraction osteogenesis was performed (group 2); and if comminution was >3 cm, distraction osteogenesis without acute shortening was performed (group 3). MAIN OUTCOME MEASUREMENTS:: Radiographic union, AOFAS ankle score. RESULTS:: Of 30 fractures, 15 fractures (50%) had an anatomic reduction of the joint. Union occurred in all but 2 fractures. Group 1 fractures healed at an average of 19 weeks (16-22). Four fractures had associated malalignment problems. The mean AOFAS score was 72.5 (range 45-100). Group 2 fractures healed at an average of 18.3 weeks (16-21). One fracture healed with 5-degrees of angulation. Group 3 fractures healed at an average of 17.5 weeks (14-24). Two fractures healed with malalignment. When groups 2 and 3 were combined to evaluate the AOFAS outcome for fractures treated with distraction osteogenesis, a score of 75.83 was obtained (45-90). There was no difference between the Group 1 versus combined Groups 2/3 with regard to this latter score (P = 0.372). Additionally, when fibula fixation (Group 1) was compared with those fractures where it was not performed (groups 2/3), no difference was seen (P = 0.276). CONCLUSIONS:: The reconstruction of severe tibial plafond fractures treated with small wire hybrid fixation may be achieved by different techniques leading to a satisfactory result. The fixation of the fibula fracture is dependent mainly on the treatment chosen for the management of the metaphyseal lesion. LEVEL OF EVIDENCE:: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Dimitris Katsenis; Vassilis Triantafillis; Marios Chatzicristos; George Dendrinos
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Publication Detail:
Journal Detail:
Title:  Journal of orthopaedic trauma     Volume:  27     ISSN:  1531-2291     ISO Abbreviation:  J Orthop Trauma     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-3-1     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8807705     Medline TA:  J Orthop Trauma     Country:  -    
Other Details:
Languages:  ENG     Pagination:  153-157     Citation Subset:  -    
*Orthopaedic Department, Argos General Hospital, Argos, Greece †Orthopaedic Department, Euroclinic Athens, Argos, Greece.
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