A tibial plafond fracture (also called a tibial pilon fracture) occurs at the end of the shin bone and involves the ankle joint. As is the case with tibial plateau fractures, these injuries occur close to the joint and must be treated with the cartilage surface of the ankle joint in mind.
Tibial plafond fractures occur just above the ankle joint and involve that critical cartilage surface of the ankle. The other major factor that must be considered with these injuries is the soft-tissue around the ankle region. Even with proper treatment, there can be both short and long-term complications of ankle joint function. People who sustain a tibial plafond fracture are at high risk of developing accelerated ankle arthritis.
Soft Tissues Around the Ankle
Because there are little muscle and skin surrounding the ankle joint, severe fractures of the tibial plafond can be problematic. If the soft-tissues are too swollen and damaged, surgery may not be possible through these damaged tissues. In these cases, definitive surgery may be delayed until the swelling subsides and the soft-tissue condition improves.
While the soft-tissue is healing, the fractured bone and ankle joint will be immobilized. This may be done with the use of a cast, splint, or external fixator. An external fixator is a device placed surgically around the soft-tissues that are swollen and damaged. The external fixator secures the bone both above and below the fracture while avoiding the soft-tissue that requires healing. The advantage of the external fixator is that it holds the bones rigidly immobilized and allows your surgeon to monitor the soft-tissue healing.
Treatment of Plafond Fractures
Once the soft-tissues will allow definitive treatment, there are several options available in the treatment of tibial plafond fractures.
Casting is used in patients who have minimal displacement of the fracture fragments. Casting may be favored in patients who have significant soft-tissue injury when surgery may not be possible.
External fixators are used for fixation in fractures that have significant soft-tissue damage. These may include open fractures or fractures with swelling that would not allow your surgeon to make incisions in the tissue. External fixators can either be used temporarily until the soft-tissue condition improves or for final treatment of the tibial plafond fractures.
Limited Internal Fixation
Limited internal fixation has become a popular option for patients who would benefit from surgery, but have soft-tissue concerns for surgery. In this case, small incisions are used to secure fracture fragments, and this treatment is augmented with the use of a cast or external fixator. This type of treatment bridges the gap between the more and less invasive treatment options.
Internal fixation of tibial plafond fractures can allow excellent restoration of the alignment of fracture fragments. Unfortunately, even with the bone fragments lined up well, ankle arthritis can result following these fractures. This so-called 'post-traumatic arthritis' is due to the cartilage damage sustained at the time of injury.
Ankle fusion is reserved for the most severe fractures that have little hope of restoring a functional ankle. The advantage of an ankle fusion is that is can provide a stable walking platform that has minimal pain.