Tibial plafond fractures develop at the end of the shin bone and involves the ankle joint. Similar with the plateau fractures, these injuries develop close to the joint and should be managed by taking into consideration the cartilage surface of the ankle joint.
When it comes to tibial plafond fractures, they occur right above the ankle joint and includes the essential cartilage surface of the ankle. Another significant factor that should be considered is the soft tissue around the ankle region. Despite proper treatment, there are both short and long-term complications of the ankle joint functionality. Individuals who ends up this type of fracture face a higher risk for developing accelerated ankle arthritis.
Close look on tissues surrounding the ankle
Due to the limited amount of skin and muscle surrounding the ankle joint, severe cases of tibial plafond fractures can be difficult. In case the soft tissues are significantly swollen and impaired, surgery is not possible via these damaged tissues. In such circumstances, definitive surgery might be delayed until the inflammation subsides and the condition improves.
Even though the soft tissue is healing, the broken bone and ankle joint should be immobilized. This is possible with a splint, cast or external fixator. An external fixator is a mechanism applied via surgery around the soft tissues that are engorged and injured. This fortifies the bone both above and below the fracture while avoiding the soft tissue that entails healing. The advantage of an external fixator is holding the bones in a rigid manner and enables the surgeon to monitor the healing process.
Management
Once the soft tissues allow definitive treatment, there are various treatment options available in treating tibial plafond fracture.
Casting
Casting is utilized among those who have minimally displaced fractured fragments. The application of a cast might be favored among those who endured significant soft tissue injury when surgery might not be a possible option.
External fixation
External fixation is utilized for fixation of fractures that sustained significant soft tissue damage. These include open fractures or cases in which the swelling will not allow the doctor to create incisions in the tissue. The external fixators can either be utilized momentarily until the condition of the soft tissue improves or for final treatment of the fracture.
Limited internal fixation
When it comes to limited internal fixation, it became a popular choice for individuals who can benefit from surgery but have soft tissue issues for surgery. In such cases, small-sized incisions are utilized to secure the fractured fragments. The treatment is augmented with a cast or external fixator. This form of treatment bridges the space between the more and less invasive treatment measures.
Internal fixation
Internal fixation of tibial plafond fractures will enable efficient restoration of the alignment of the fractured fragments. It is sad to note that even with the bony fragments properly lined up, ankle arthritis can develop after these fractures.
Ankle fusion
Ankle fusion is usually reserved for severe cases of fractures that have limited hope of restoring full functionality of the ankle. The advantage of an ankle fusion can provide a stable walking platform that causes minimal pain.