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Tibial Plafond Fractures
Posted: Aug 5 2019 #(C101230)
A

Tibial Plafond Fracture in 47F

HPI

The patient is a 47-year-old female that fell 10-feet off a wall while participating in a outdoor obstacle course race 2 weeks ago. She presented to an outside ER with pain, swelling, and deformity of the left ankle. The injury was closed. She underwent closed reduction and external fixation application.  She now presents to my clinic 2 weeks later.  She reports no prior left ankle pain or history of previous injuries.

PMH

Her past medical history includes allergic rhinitis, anxiety, depression, irritable bowel syndrome, restless leg syndrome, and obesity.  Her past surgical history includes reduction mammoplasty x2, tonsillectomy. She is a non smoker, reports 1-2 drinks per week, denies illicit drugs, and works at a desk job but remains active recreationally.

PE

On physical exam, her ex-fix is in place. There is visible ankle malalignment. The pin sites are clean and dry. The skin is intact. She has moderate swelling. She is neurovascularly intact with palpable DP and PT pulses.

Poll
1 of 11
1. Would you use a classification system to guide management?
No - a classification system would not help me
38%
495/1284
Yes - Ruedi and Allgower
16%
212/1284
Yes - AO/OTA
36%
471/1284
Yes - Other
1%
13/1284
Outside my area of expertise - best if I don't vote
7%
93/1284
2. How would you manage the patient at this time?
Nonoperative - maintain in current external fixator (ExFix)
2%
36/1291
Operative - recommend additional surgery
95%
1236/1291
Outside my area of expertise - best if I don't vote
1%
19/1291
3. If you choose Operative management, now that the patient is 2 weeks out from injury, when would you plan to take this patient to surgery?
I would not choose Operative management
0%
3/1271
Tonight - following clinic
3%
50/1271
Next day - first case (cancel or bump other cases)
20%
263/1271
Within the next 4 days
46%
587/1271
Within the next week (4-7 days)
23%
297/1271
>7 days (as schedule permits)
3%
50/1271
Outside my area of expertise - best if I don't vote
1%
21/1271
4. If you choose Operative management, which treatment would you choose for the tibia?
I would not choose Operative management
0%
2/1256
Revision Ex-fix (includes limited internal fixation)
11%
141/1256
Open reduction internal fixation (ORIF)
85%
1069/1256
Intramedullary nail (IMN) fixation
0%
10/1256
Primary arthrodesis
1%
17/1256
Outside my area of expertise - best if I don't vote
1%
17/1256
5. If you choose Open reduction internal fixation (ORIF) of the tibia, what approach(es) would you use?
I would not choose ORIF of the tibia
0%
8/1237
Anterolateral (AL) only
6%
83/1237
Anteromedial (AM) only
8%
106/1237
Direct anterior (DA) only
3%
45/1237
Medial (M) only
0%
6/1237
Posteromedial (PM) only
0%
11/1237
Posterolateral (PL) only
0%
8/1237
Achilles split (AS) only
0%
2/1237
Combination of TWO approaches above
67%
831/1237
Combination of THREE approaches above
6%
84/1237
Outside my area of expertise - best if I don't vote
4%
53/1237
6. If you choose Open reduction internal fixation (ORIF) of the tibia, where would you place your primary source of fixation (plate) for the tibia?
I would not choose ORIF of the tibia
0%
8/1201
Posterior
20%
247/1201
Anterolateral
47%
575/1201
Medial
27%
331/1201
Outside my area of expertise - best if I don't vote
3%
40/1201
7. If you choose Open reduction internal fixation (ORIF) of tibia, would you plan on using bone graft?
I would not choose ORIF of the tibia
0%
5/1169
No - not necessary
23%
279/1169
Yes - synthetic substitute (e.g. CaPhos)
18%
214/1169
Yes - allograft (e.g. DBM/DBX)
29%
341/1169
Yes - autograft
24%
283/1169
Outside my area of expertise - best if I don't vote
4%
47/1169
8. If you choose Open reduction internal fixation (ORIF) of tibia, would you include fixation of the fibula?
I would not choose ORIF of the tibia
0%
2/1159
No - I would NOT fix the fibula
6%
75/1159
Yes - I would fix the fibula
90%
1054/1159
Outside my area of expertise - best if I don't vote
2%
28/1159
9. If you choose to Fix the fibula, what type of fixation would you use?
I would not choose to Fix the fibula
1%
19/1137
Open reduction internal fixation (ORIF) - separate approach from the tibia
57%
659/1137
ORIF - same approach as the tibia
27%
311/1137
Intramedullary fixation (includes screw, flex nail, wire)
10%
124/1137
Outside my area of expertise - best if I don't vote
2%
24/1137
10. If you choose to Fix the fibula, when would you fix it?
I would not choose to Fix the fibula
1%
12/896
Before the tibia
66%
598/896
After the tibia
29%
266/896
Outside my area of expertise - best if I don't vote
2%
20/896
11. If you choose Operative management and attained the construct shown below, how would you maintain the patient non-weight-bearing post-operatively?
I would not choose Operative management
0%
0/1121
I would not restrict weight bearing
0%
1/1121
1-2 weeks
1%
13/1121
3-4 weeks
3%
42/1121
5-6 weeks
34%
391/1121
7-9 weeks
20%
228/1121
10-12 weeks
32%
366/1121
>12 weeks
5%
62/1121
Outside my area of expertise - best if I don't vote
1%
18/1121
PROCEDURE #1 DOP: 8/5/2019

Open reduction internal fixation left distal tibia

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OUTCOMES
Post-procedure P1
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