Long-term results of tibial plafond fractures treated with open reduction and internal fixation.

In this study a series of 41 consecutive cases of operatively treated fractures of the tibial plafond was retrospectively analysed. The fractures were classified into types I (9.75%), II (41.5%) and III (48.75%) as defined by Rüedi. The 10-year average follow-up revealed 66% good and 24% fair objective results overall. The recent literature uniformly reports good results in operatively treated type-I and -II fractures. In this series, these essentially low-velocity injuries resulted in a satisfactory outcome in 86% of cases. Controversy exists in reports of operative treatment of type-III fractures. The incidence of satisfactory results in the present series in type-III fractures was 95% good and fair results, which appears to be better than in other authors' experience. This can be partially explained by the relatively few high-velocity injuries (50% of the type-III fractures) and also by certain technical procedures used in surgery to stabilise these fractures. The initial type of fracture and articular cartilage damage are directly related to late arthrosis. There is clear evidence that the quality of reduction correlates with later development of arthrosis. However, anatomical reduction may still be followed by significant joint arthrosis because of articular cartilage damage. Severe arthrosis present at late follow-up did not correlate with poor subjective or objective results. With adequate open reduction and internal fixation, satisfactory results can be obtained in severe tibial plafond fractures. Meticulous soft tissue care and handling at surgery are important. Various fixation devices may need to be incorporated to ensure optimal soft tissue status for fracture healing.