Postoperative Radiographic and Clinical Assessment of the Treatment of Posterior Tibial Plafond Fractures Using a Posterior Lateral Incisional Approach |
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| Affiliation: | 1. Fellowship Director, Department of Foot Ankle, Coordinated Health, Bethlehem, PA;2. Fellow, Department of Foot Ankle, Coordinated Health, Bethlehem, PA;3. Research Associate, Department of Clinical Education and Research, Coordinated Health, Bethlehem, PA;1. Associate Professor, Department of Surgery, Texas A&M Health and Science Center College of Medicine, College Station, TX; Chief, Section of Podiatry, Department of Surgery, Central Texas Veterans Affairs Health Care System, Temple, TX; and Staff, Baylor Scott and White Health Care System, Temple, TX;2. Postgraduate Year III Resident, Scott and White Health Science Center, Texas A&M University Health Science Center College of Medicine, Temple, TX;3. Postgraduate Year II Resident, Scott and White Health Science Center, Texas A&M University Health Science Center College of Medicine, Temple, TX;4. Clinical Assistant Professor, Department of Surgery, Texas A&M Health and Science Center College of Medicine; and Staff, Section of Podiatry, Department of Surgery, Central Texas Veterans Affairs Health Care System, Waco, TX;1. Professor, New York College of Podiatric Medicine, New York, NY;2. Resident, St. Barnabas Medical Center, Livingston, NJ;3. Student, New York College of Osteopathic Medicine, Old Westbury, NY;4. University of Delaware, Newark, DE;5. Practicing Physician, Medical Arts Radiology, Commack, NY;6. Attending Physician, Long Island Jewish Hospital, New Hyde Park, NY;1. Department of Orthopaedic Surgery, San Antonio Military Medical Center, San Antonio, TX;2. Department of Orthopaedic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX |
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| 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. |
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| Keywords: | ankle fracture internal fixation open reduction posterolateral approach posterior malleolus |
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