Tibial Plafond Fractures
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- Tibial plafond (“pilon”) fractures involve the distal articular surface of the tibia and extend to the metaphysis.
- Term first introduced as description of the distal tibial metaphysis—pestle-shaped “pilon”
- Plafond (French for “ceiling”) refers to the horizontal distal tibial articular surface.
- Tibial plafond fractures often involve significant soft tissue injuries, neurovascular compromise, and concomitant multisystem trauma.
- Tibial plafond fractures typically result from:
- High-energy injuries with severe axial load (motor vehicle accident [MVA], fall from significant height), leading to impaction, comminution, and soft tissue injury. Approximately 15–52% have other associated fractures, necessitating a careful primary and secondary trauma survey.
- Lower energy injuries involve torsional forces, commonly in sporting accidents (skiing, basketball, soccer).
- Low-energy trauma can also occur in the elderly due to osteopenia.
- Multiple fracture classification systems exist. The most commonly used is the Rüedi and Allgöwer classification system.
- Type I: fracture of the distal tibia without significant displacement of the articular surface
- Type II: significant displacement of the articular surface, but the joint surface is neither crushed nor grossly comminuted
- Type III: involves both comminution and impaction of the distal tibial articular surface and metaphysis
- This system has low interrater reliability, especially between types II and III. The AO/OTA classification (1) has superior interrater agreement and has become more prominent.
- Type A: extra-articular fractures
- Type B: partial articular fractures
- Type C: complete articular fractures with metaphyseal–diaphyseal dissociation
- Further subcategorization describes comminution and impaction.
- Group 1: no comminution or impaction in both the articular and metaphyseal areas
- Group 2: impaction involving only the supra-articular metaphysis
- Group 3: comminution and impaction involving both the articular surface and metaphyseal region
- Tibial plafond fractures account for 3–10% of tibial fractures and <1% of all lower extremity fractures.
- Men > women 3:1
- More common in 4th decade of life
- Of high-energy injuries, 30–50% are open fractures.
- The increased incidence of tibial plafond fractures associated with improved survival rate from MVAs
- Young males, most common in 4th decade of life
- Associated alcohol abuse or drug use
- Working at heights
Elderly patients are susceptible to fractures associated with low-energy trauma due to osteopenia/osteoporosis.
Commonly Associated Conditions
- Degloving/crushing (common in high-energy trauma)
- Compartment syndrome
- Skin necrosis
- Injuries to the contralateral leg and foot
- Peroneal nerve damage
- Associated multisystem traumatic injuries (pelvic, spinal, abdominal, thoracic, or cranial)