Surgical management strategies in high energy plafond tibial fractures. Sistematic review
Abstract
Tibial plafond fractures are serious injuries affecting the epiphyseal and metaphyseal distal tibial bone. Usually they are caused by a high energy traumatic mechanism with axial compression and are often associated with soft tissue injuries. Different methods of treatment have been used depending on the type of fracture and especially the severity of soft tissue damage. The aim of our study was to review the different therapeutic strategies available for the treatment of C2 and C3 type tibial plafond fractures according to the Association of Osteosynthesis and Orthopaedic Trauma Association system, AO-OTA. The level of evidence and grade of recommendation of each strategy was determined. The search was conducted at: Medline (PubMed interface), Scopus and Cochrane Library including the last ten years studies. Eleven articles where finally selected. Given the heterogeneity of these works, we divided them into three subgroups for better assessment of the results. Open reduction and internal fixation had a lower rate of infection and nonunion, with better functional outcome. In external fixation, the use of articulated device at the ankle was not different from the non articulated ones regarding functional outcome and arthritis. The evidence is not conclusive regarding the timing of fibula fixation.
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