Its radiologic findings are similar to those of osteochondritis dissecans located elsewhere in the body. Diagnosis is typically made through clinical evaluation and confirmed with plain radiographs. The goal of therapy is to reduce the fracture and begin early mobilization. External fixators are used for fixation in fractures that have significant soft-tissue damage. Even with proper treatment, there can be both short and long-term complications of ankle joint function. Osteochondritis dissecans of the tibial plafond is a rare condition that may not be detectable on radiography. Tibial plafond fractures occur just above the ankle joint and involve that critical cartilage surface of the ankle. A 52-year-old carpenter falls off of a balcony while at work and sustains the injury shown in Figure A. 1. Tibial plateau fractures: evaluation with multidetector-CT. Radiol Med. What would be the most appropriate sequence of treatment steps for definitive management of this injury? For such patients, the radiographic modality for measuring tibial torsion can be limited to CT. With the mobile application, an accurate torsional profile can be achieved without having to expose patients to high-dose radiation. Tibial plafond fracture patients with minimum 12-month follow-up treated at a level 1 trauma center from 2006 to 2019 were categorized into high (top 25%) vs average-low (AL) (bottom 75%) performers based on PROMIS PF scores. - Niloofar Dehghan, MD, MSc, FRCSC, Orthopaedic Summit Evolving Techniques 2020, Evolving Technique Update: Distal Tibial Fractures With Osteoporosis & Neuropathy: A Different Playbook - Stephen A. Kottmeier MD, Trauma Tibial Plafond Fractures (ft. Dr. Brian Weatherford). Copyright 2022 Lineage Medical, Inc. All rights reserved. The fractures involve the medial malleolus, the posterior aspect of the tibial plafond (referred to as the posterior malleolus) and the lateral malleolus. Verywell Health's content is for informational and educational purposes only. Depression of a tibial plateau that is inadequately corrected results in a varus or valgus deformity and accelerated osteoarthritis. In a pilon fracture, the Chaput fragment typically maintains soft tissue attachment via which of the following structures? A 45-year-old male construction worker presents with right ankle pain after falling from a two-story building and landing on his right leg. These may include. Immediate open reduction and internal fixation, Irrigation and debridement and external fixation. He served as assistant team physician to Chivas USA (Major League Soccer) and the United States men's and women's national soccer teams. 2 2 Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA. Pilon fractures of the ankle. Kenneth J. Koval (Editor), Joseph D. Zuckerman (Editor). Int Orthop. CONCLUSION. Two years following surgery, which of the following parameters will most likely predict a poor clinical outcome and inability to return to work? (OBQ13.135) (SBQ18TR.27) (OBQ11.103) (OBQ05.157) The knee is a complex synovial joint that can be affected by a range of pathologies: ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Casting is used in patients who have minimal displacement of the fracture fragments. What is the most appropriate next step in treatment? Rafii M, Firooznia H, Golimbu C et-al. This so-called post-traumatic arthritis is due to the cartilage damage sustained at the time of injury. Tap on the below button when you are Online. AJR Am J Roentgenol. 4. Bauer et al. A tibial plafond fracture (also called a tibial pilon fracture) occurs at the end of the shin bone and involves the ankle joint. She is otherwise healthy, but routinely smokes 30 cigarettes per day. Impression fractures of the anterolateral tibial plafond (type 3) necessitate elevation with restoration of the joint surface, bone grafting of the impaction zone as needed and anterior buttress plating. Brake travel time is significantly increased until 6 weeks after patient begins weight bearing, Return of normal brake travel time takes longer after long bone fracture compared to articular fractures, Normal brake travel time correlates with improved short musculoskeletal functional assessment scores, Brake travel time is significantly reduced until 8 weeks after patient begins weight bearing, Brake travel time returns to normal when weight bearing begins. What is the most appropriate definitive treatment? Schatzker VI: transverse tibial metadiaphyseal fracture, along with any type of tibial plateau fracture. The advantage of an ankle fusion is that is can provide a stable walking platform that has minimal pain. Conclusion: Osteochondral lesions of the distal tibia most commonly occurred at the central-medial tibial plafond. Plain radiography often underestimates the severity of the injury. A 37-year-old construction worker falls off a rock and lands on his right leg. Chummy S. Sinnatamby. Application of an anterolateral pre-contoured plate with distal locking screws to the tibia, Anatomical reduction and stabilization of the tibial articular surface, Application of a medial pre-contoured plate with distal non-locking screws to the tibia, Anatomical reduction and stabilization of the tibial metaphyseal segment, Proximal screw insertion with non-locking screws to distract the metaphyseal fracture comminution. In addition to these well-described potential diagnostic pitfalls, we have seen several instances in which the osteochondral contour at the anteromedial margin of the tibial plafond was interpreted by radiologists and other physicians as a pathologic osteochondral lesion (or defect). Unfortunately, even with the bone fragments lined up well, ankle arthritis can result following these fractures. (OBQ06.8) We report the imaging characteristics of osteochondritis dissecans of the tibial articular surface (tibial plafond). 1 Department of Radiology, University of California, Davis, 4860 Y St, Ste 3100, Sacramento, CA 95817. . CT is very helpful in accurately defining the extent of the bony injury and facilitates orthopedic intervention. Tibial plateau fracture. [6] re-ported on a series of 30 patients who had os-teochondritis dissecans of the ankle. Having three parts, this is a more unstable fracture and may be associated with ligamentous injury. To injure the medial plateau, a large amount of force is required; fractures of the medial plateau are usually seen in conjunction with fractures of the lateral plateau and other bones around the knee 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. A 34-year-old male sustains the closed injury seen in Figure A as a result of a high-speed motor vehicle collision. Although these articles do not have all bibliographic details available yet, they can be cited using the year of online publication and the DOI as follows: Please consult the journal's reference style for the exact appearance of these elements, abbreviation of journal names, and use of punctuation. (OBQ04.216) He was treated initially with external fixation for 11 days before his soft-tissues would permit definitive open internal fixation. Its radiologic findings are similar to those of osteochondritis dissecans located elsewhere in the body. A 32-year-old man sustains a pilon fracture which is treated initially with a spanning external fixator, as shown in figure A. . AJR Am J Roentgenol. The other major factor that must be considered with these injuries is the soft tissue around the ankle region. Ankle fusion is reserved for the most severe fractures that have little hope of restoring a functional ankle. Ho B, Ketz J. Injury radiographs are shown in figures A and B. Clinical presentation They can be found in asymptomatic individuals or in patients who present with anterior ankle pain. There are also associated fractures of the talar dome and tip of the lateral malleolus. In younger patients, the most common pattern of fracture is splitting, while in older, more osteoporotic patients, depression fractures typically are sustained. Kenneth A. Egol, Kenneth J. Koval, Joseph David Zuckerman. Because there are little muscle and skin surrounding the ankle joint, severe fractures of the tibial plafond can be problematic. Jonathan Cluett, MD, is board-certified in orthopedic surgery. A 34-old-male was involved in a high speed MVC. (OBQ04.73) (OBQ12.199) 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. subchondral edema signal or cystic change at the tibial plafond, and the presence of an ankle joint effusion. Immediate definitive fixation of the tibia, and nonoperative treatment of the fibula, Immediate ankle-spanning external fixation device with consideration of immediate fixation of the fibula, followed by delayed reconstruction of the tibia, Placement of a temporary splint, elevation, and definitive fixation 1 week from injury, Immediate definitive fixation of the tibia and fibula, Immediate placement of a spanning Ilizarov fixator with limited internal fixation of the distal tibia and fibula. The advantage of the external fixator is that it holds the bones rigidly immobilized and allows your surgeon to monitor the soft tissue healing. People who sustain a tibial plafond fracture are at high risk of developing accelerated ankle arthritis. Larger fragments involving the tibial incisura and plafond (type 2) are mostly fixed with screws. LIST YOUR PRACTICE ; Dentist ; Search . (2004) ISBN: 9780781717885 -, 3. (2011) ISBN: 9780702033957 -, 2. Find the code on the page and enter it above. You can rate this topic again in 12 months. Last's Anatomy. It shows a just discernable fracture line at the typical location: the junction of the tibial plafond and inner vertical line of the medial malleolus Bilateral stress fracture of the distal fibula: Initial radiographs and Bone scintigraphy at 2 weeks follow up. Macarini L, Murrone M, Marini S et-al. 1984;142 (6): 1181-6. Its radiologic findings are similar to those of osteochondritis dissecans located elsewhere in . Features of impaction are consistent with an axial loading mechanism, which is typically associated with this type of injury. Please wait while the data is being loaded.. Visit https://www.ajronline.org/pairdevice on your desktop computer. The most common mechanism of injury involves axial loading, e.g. 2. [ 1 - 3] pilon fractures are very rare, with an (SBQ18TR.26) What is true regarding the anterolateral approach for this injury? the tibial plafond of 9:2. Rafii M, Firooznia H, Golimbu C et-al. The patient reveals he never completed a high school degree, smokes 1/2 a pack of cigarettes per day, and occasionally uses marijuana recreationally. Methods. 1 1 Department of Radiology, University of California, Davis, 4860 Y St, Ste 3100, Sacramento, CA 95817. Tibial plateau. Parameters measured included area of the OLT, tibial axis-medial malleolus angle (TMM), malleolar width (MalW), and talar surface angle (TSA; defined as the angle between the line perpendicular to the mid-diaphysis of the tibia and the talar joint surface . American Academy of Orthopaedic Surgeons. Content is reviewed before publication and upon substantial updates. The following criteria were analyzed: the presence or absence of a fracture in the posteromedial corner of the tibial plafond, loose posterior osteochondral fragments, impaction of posterior osteochondral fragments on the anteroposterior and the lateral radiographs, and size of the posterolateral fragment as percentage of the articular surface . Unappreciated ligamentous injury causes greater than normal stress on the remaining support structures of the joint, malalignment, and the development of premature osteoarthritis. The tibial plateau is composed of two parts: concave articular surfaces of the oval-shaped medial and circular-shaped lateral tibial condyles (medial and lateral tibial plateaus) the medial tibial condyle is larger, stronger and transmits more weight than the lateral tibial condyle central non-articular intercondylar area Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Tibial plateau fractures are complex injuries that require adequate imaging to assess prior to fixation. The external fixator secures the bone both above and below the fracture while avoiding the soft tissue that requires healing. Book an appointment today! Physical examination reveals diffuse soft tissue swelling around the ankle joint without any open injuries. tibial plateau fracture classification systems traditionally used by radiologists and orthopedic surgeons, including the schatzker and the arbeitsgemeinschaft fr osteosynthesefragen-orthopedic trauma association (ao-ota) classification systems, rely on findings at anteroposterior radiography and lack the terminology to accurately characterize Primary arthrodesis for tibial pilon fractures. Foot Ankle Clin. MRI is very helpful in the assessment of soft tissue injury around the joint. The Schatzker classification is a useful classification to categorize the mechanism of injury 1: Tibial plateau fractures are complex injuries that require adequate imaging to assess prior to fixation. When dividing the tibial plafond into nine equal zones (using a 3 3 grid), the most common sites for osteochondral lesions are at the midmedial and the posterior-medial segments . Current imaging is shown in figures A-C. On examination, the injury is closed, but there is substantial soft tissue swelling. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Fractures of the lateral plateau are much more common than the medial plateau. 3. 2017;22(1):147-161. doi:10.1016/j.fcl.2016.09.010. Tibial-plafond (Pilon) fractures from Section II - Trauma radiology Published online by Cambridge University Press: 22 August 2009 James R. D. Murray , Erskine J. Holmes and Rakesh R. Misra Chapter Get access Summary A summary is not available for this content so a preview has been provided. Osteochondritis dissecans of the tibial plafond is a rare condition that may not be detectable on radiography. Varus collapse of the distal tibia at the time of injury, Use of more than one plate for definitive fixation of the tibia. Editors of Chambers, Ian Brookes. Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. This site uses cookies. Comminuted distal tibial fracture with coronally oriented fracture component, extending into the medial malleolus, with focal zone of depression comprising 30% of the tibial plafond with maximal depression of 1 cm. She sustained the isolated, closed injury shown in Figures A and B. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. There is a comminuted distal tibial fracture extending into the tibial plafond, representing a Pilon fracture. Unable to process the form. The tibial plateau is composed of two parts: Via the medial and lateral menisci the tibial plateau articulates with the medial and femoral condyles to form the tibiofemoral part of the knee joint. Computed tomography of tibial plateau fractures. The other major factor that must be considered with these injuries is the soft tissue around the ankle region. A 46-year-old male falls 15 feet from a ladder while working. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Plain radiograph Osteochondritis dissecans of the tibial plafond is a rare condition that may not be detectable on radiography. A 35-year-old male laborer falls off a ladder and sustains the injury shown in Figures A and B. Casting may be favored in patients who have significant soft-tissue injury when surgery may not be possible. He reports severe pain and inability to bear weight on the right leg. (SBQ12TR.30) Jonathan Cluett, MD, is a board-certified orthopedic surgeon with subspecialty training in sports medicine and arthroscopic surgery. A 33-year-old male sustains the injury shown in Figure A. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Knipe H, Bell D, Hacking C, et al. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Radswiki T, Lustosa L, Er A, et al. Thank you, {{form.email}}, for signing up. Internal fixation of tibial plafond fractures can allow excellent restoration of the alignment of fracture fragments. Which of the following treatment regimens has been shown to decrease wound complications in the definitive management of these injuries? A 45-year-old male laborer falls off a 15 foot retaining wall 6 hours ago and sustains an open fracture shown in Figures A through C. He has a normal neurovascular exam. Differential diagnosis open reduction internal fixation of the fibula only, open reduction internal fixation of the tibia and fibula, removal of external fixator and conversion to a walking cast. 2022 Dotdash Media, Inc. All rights reserved. Which of the following statements is true regarding brake travel time after surgical treatment of complex lower extremity trauma? Find top doctors who treat Osteo Chondral Defects Talus and Tibial Plafond near you in Los Angeles, CA. Author(s), Article title, Publication (year), DOI. Trimalleolar fractures refer to a three-part fracture of the ankle. Check for errors and try again. The location you tried did not return a result. In these cases, definitive surgery may be delayed until the swelling subsides and the soft tissue condition improves. The Chambers Dictionary. Distal tibial triplane features, which constitute 6%-10% of epiphyseal injuries, are most accurately delineated and analyzed with computed tomography (CT). The patient undergoes an ankle-spanning external fixator placement for soft tissue stabilization and then undergoes definitive fixation shown in figures C and D. Which factor suggests a poor clinical outcome and failure to return to work? Book an appointment today! Computed tomography of tibial plateau fractures. Strictly the plateau refers to the whole articular surface of the proximal tibia. Find top doctors who treat Osteo Chondral Defects Talus and Tibial Plafond near you in Los Angeles, CA. An ankle spanning external fixator is placed on the right leg to allow for soft tissue stabilization. The injury is closed, and soft tissues are intact upon arrival. 2009;29 (2): 585-597. 5, 9,10,31 Although the exact pathophysiological mechanisms of injury in OLTPs have not been determined, the stiffer articular cartilage lining the surface of the tibial plafond together with the . (OBQ08.182) This may be done with the use of a cast, splint, or external fixator. to cruciate and collateral ligaments) occur in approximately 10% of patients. . Find a doctor near you. Reference article, Radiopaedia.org (Accessed on 11 Dec 2022) https://doi.org/10.53347/rID-28729, Figure 1: proximal tibia (Gray's illustration), posterior suprapatellar (prefemoral or supratrochlear) fat pad, anterior suprapatellar (quadriceps) fat pad, accessory anterior inferior tibiofibular ligament, superficial posterior tibiotalar ligament, superficial posterior compartment of the leg (calf), accessory extensor digiti secundus muscle, descending branch of the lateral circumflex, concave articular surfaces of the oval-shaped medial and circular-shaped lateral tibial condyles (medial and lateral tibial plateaus), the medial tibial condyle is larger, stronger and transmits more weight than the lateral tibial condyle, site of attachment of menisci and cruciate ligaments, the tibial plateau slopes posteroinferiorly 10-15 degrees; thus anterior tibial plateau fractures may be occult on AP projections, 1. Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. What is the most appropriate next step in management? This type of treatment bridges the gap between the more and less invasive treatment options. (OBQ05.93) tibial pilon fractures (types b3 and c according to the ao/ota fracture and dislocation classification) are predominantly the result of high-energy trauma and are often associated with comminuted joint surface, displacement, and often associated with extensive soft-tissue damage or open fractures. A tibial plafond fracture (also known as a pilon fracture) is a fracture of the distal end of the tibia, most commonly associated with comminution, intra-articular extension, and significant soft tissue injury. The fracture pattern will depend on the mechanism of injury. The tibial plateau(plural: plateaus or plateaux are equally acceptable 4) is the proximal articular surface of the tibia. Use the menu to find downloaded articles. CONCLUSION. By continuing to browse the site you are agreeing to our use of cookies. fall from a significant height. Coronal and sagittal CT scan images are shown in Figures D and E. What is the MOST appropriate next step in management in addition to operative irrigation and debridement? While the soft tissue is healing, the fractured bone and ankle joint will be immobilized. Diagnosis is typically made through clinical evaluation and confirmed with plain radiographs. If the soft tissues are too swollen and damaged, surgery may not be possible through these damaged tissues. Eva Umoh Asomugha, MD, is a board-certified orthopedic surgeon who specializes in all conditions involving the foot and ankle region. He has a 2 cm laceration over the medial ankle with exposed bone and a normal neurovascular exam. A 55-year-old female presents to the emergency room after falling off her balcony. We report the imaging characteristics of osteochondritis dissecans of the tibial articular surface (tibial plafond). The treating surgeon decides to perform an open reduction internal fixation (ORIF) through combined anterolateral and medial approaches. Thank you. Osteochondritis dissecans of the tibial plafond is a rare condition that may not be detectable on radiography. Please enter a valid 5-digit Zip Code. Case 10: medial tibial plateau fracture (3D reformat), Case 11: Schatzker type II tibial plateau fracture, Gustilo Anderson classification (compound fracture), Anderson and Montesano classification of occipital condyle fractures, Traynelis classification of atlanto-occipital dissociation, longitudinal versus transverse petrous temporal bone fracture, naso-orbitoethmoid (NOE) complex fracture, cervical spine fracture classification systems, AO classification of upper cervical injuries, subaxial cervical spine injury classification (SLIC), thoracolumbar spinal fracture classification systems, AO classification of thoracolumbar injuries, thoracolumbar injury classification and severity score (TLICS), Rockwood classification (acromioclavicular joint injury), Neer classification (proximal humeral fracture), AO classification (proximal humeral fracture), AO/OTA classification of distal humeral fractures, Milch classification (lateral humeral condyle fracture), Weiss classification (lateral humeral condyle fracture), Bado classification of Monteggia fracture-dislocations (radius-ulna), Mason classification (radial head fracture), Frykman classification (distal radial fracture), Hintermann classification (gamekeeper's thumb), Eaton classification (volar plate avulsion injury), Keifhaber-Stern classification (volar plate avulsion injury), Judet and Letournel classification (acetabular fracture), Harris classification (acetebular fracture), Young and Burgess classification of pelvic ring fractures, Pipkin classification (femoral head fracture), American Academy of Orthopedic Surgeons classification (periprosthetic hip fracture), Cooke and Newman classification (periprosthetic hip fracture), Johansson classification (periprosthetic hip fracture), Vancouver classification (periprosthetic hip fracture), Winquist classification (femoral shaft fracture), Schatzker classification (tibial plateau fracture), AO classification of distal femur fractures, Lauge-Hansen classification (ankle injury), Danis-Weber classification (ankle fracture), Berndt and Harty classification (osteochondral lesions of the talus), Sanders CT classification (calcaneal fracture), Hawkins classification (talar neck fracture), anterior superior iliac spine (ASIS) avulsion, anterior cruciate ligament avulsion fracture, posterior cruciate ligament avulsion fracture, avulsion fracture of the proximal 5th metatarsal, Ahlback classification system in assessing osteoarthritis of the knee joint, Kellgren and Lawrence system for classification of osteoarthritis, anterior cruciate ligament mucoid degeneration, MRI grading system for meniscal signal intensity, valgus force with axial loading (femoral condyle rams the tibial plateau), valgus force (moderate association with medial collateral ligament and medial meniscus injury), complex high energy mechanism involving varus OR valgus forces with significant axial loading. His wounds healed without infection or other complications. (2010) ISBN: 9781605477602 -, 4. Even with proper treatment, there can be both short and long-term complications of ankle joint function. Two patients (7%) had osteochondritis dissecans of the tibial plafond; the remaining had osteo-chondritis dissecans of the talar dome, giving a ratio of talar dome to tibial plafond of 28:2 or 14:1. Limited internal fixation has become a popular option for patients who would benefit from surgery, but have soft-tissue concerns for surgery. Reference article, Radiopaedia.org (Accessed on 11 Dec 2022) https://doi.org/10.53347/rID-15615, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":15615,"questionManager":null,"mcqUrl":"https://radiopaedia.org/articles/tibial-plateau-fracture/questions/1930?lang=us"}. This is directly related to the special geometry of these fractures that have important transverse components. The entire articular surface cannot be visualized through the anterolateral approach, Anterior compartment tendons are retracted laterally to protect the neurovascular structures, Anterolateral approach is contraindicated with central dome comminution, Dorsal foot numbness is the most common associated neurologic complication, Fibular fixation is usally performed through the same incision. 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