Closed intra-articular tibial plafond fractures managed with circular external fixation: clinical outcomes at a South African tertiary hospital

Abstract

Background: Tibial plafond fractures are complex injuries involving the distal tibiotalar cartilage, and the mechanism of injury is usually high energy. The approach to management is complicated by soft tissue compromise and the lack of consensus regarding a superior fixation method. Complications result in long-term functional and social disability. This study aimed to assess the short-term outcomes and complications in patients with closed tibial plafond fractures surgically managed with circular external fixation (CEF).

Methods: We retrospectively reviewed a series of patients diagnosed with closed tibial plafond fractures in a tertiary hospital in South Africa between January 2016 and December 2019. We identified 35 patients who underwent surgical management with CEF. We assessed files for inpatient notes, outpatient follow-up notes, and radiographic analysis. Clinical data collected included demographics, comorbidities, postoperative complications, and the need for reoperation. Radiological data included reduction, fracture union, equinus, and post-traumatic osteoarthritis on X-rays at the final follow-up.

Results: The cohort was predominantly male (n = 29 of 35, 83%), with a median age of 38 years (interquartile range [IQR] 32–46 years). The mechanism of injury was found to be high-energy trauma in 23 patients (66%). The median follow-up period was 28 weeks (IQR 24–43 weeks). Ninety-one per cent of patients achieved fracture union (n = 32 of 35) at a median of 19 weeks (IQR 17–24 weeks). High-energy mechanism of injury showed a statistically significant increase in time to union for patients (p = 0.034). Radiological reduction was acceptable to good in 69% of patients. The superficial sepsis rate was 29%, with one patient (3%) developing deep sepsis. Diabetes mellitus was seen as a significant risk factor. Eighty-five per cent of patients (n = 28 of 35) developed post-traumatic arthritis of the ankle joint.

Conclusion: Our study showed a high rate of fracture union and acceptable reduction with this treatment method. Ankle radiological outcomes are affected, with patients developing equinus deformities and post-traumatic ankle arthritis. Further prospective studies are required to determine longterm outcomes.

Level of evidence: Level 4