Operative Treatment of Fractures of the Tibial Plafond. A Randomized, Prospective Study*

by BRAD WYRSCH, MARK A. MCFERRAN, MARK MCANDREW, THOMAS J. LIMBIRD, MARION C. HARPER, KENNETH D. JOHNSON, and HERBERT S.

SCHWARTZ

J Bone Joint Surg AmVolume 78(11):1646-57

November 1, 1996

©1996 by The Journal of Bone and Joint Surgery, Inc.

Figs. 1-A through 1-E: Case 4, a sixteen-year-old girl who sustained a closed type-I fracture of the tibial plafond in a motor-vehicle accident.

BRAD WYRSCH et al. J Bone Joint Surg Am 1996;78:1646-57

©1996 by The Journal of Bone and Joint Surgery, Inc.

Figs. 1-A through 1-E: Case 4, a sixteen-year-old girl who sustained a closed type-I fracture of the tibial plafond in a motor-vehicle accident.

BRAD WYRSCH et al. J Bone Joint Surg Am 1996;78:1646-57

©1996 by The Journal of Bone and Joint Surgery, Inc.

Fig. 1-C: Anteroposterior radiograph made after open reduction and internal fixation.

BRAD WYRSCH et al. J Bone Joint Surg Am 1996;78:1646-57

©1996 by The Journal of Bone and Joint Surgery, Inc.

Figs. 1-D and 1-E: Anteroposterior and lateral radiographs made two years after the injury.

BRAD WYRSCH et al. J Bone Joint Surg Am 1996;78:1646-57

©1996 by The Journal of Bone and Joint Surgery, Inc.

Figs. 1-D and 1-E: Anteroposterior and lateral radiographs made two years after the injury.

BRAD WYRSCH et al. J Bone Joint Surg Am 1996;78:1646-57

©1996 by The Journal of Bone and Joint Surgery, Inc.

Figs. 2-A through 2-D: Case 22, a fifty-year-old man who sustained an open type-III fracture of the tibial plafond in a fall from a tree stand.

BRAD WYRSCH et al. J Bone Joint Surg Am 1996;78:1646-57

©1996 by The Journal of Bone and Joint Surgery, Inc.

Fig. 2-B: Anteroposterior radiograph made after immediate débridement followed by limited internal fixation and placement of an external fixator.

BRAD WYRSCH et al. J Bone Joint Surg Am 1996;78:1646-57

©1996 by The Journal of Bone and Joint Surgery, Inc.

Fig. 2-C: Anteroposterior radiograph made eleven months postoperatively, demonstrating union with moderate narrowing of the joint space.

BRAD WYRSCH et al. J Bone Joint Surg Am 1996;78:1646-57

©1996 by The Journal of Bone and Joint Surgery, Inc.

Anteroposterior and lateral radiographs made at twenty-nine months.

BRAD WYRSCH et al. J Bone Joint Surg Am 1996;78:1646-57

©1996 by The Journal of Bone and Joint Surgery, Inc.

Figs. 3-A through 3-E: Anteroposterior radiographs of Case 10, a thirty-five-year-old man who sustained a closed type-I fracture of the tibial plafond in a motor-vehicle accident.

BRAD WYRSCH et al. J Bone Joint Surg Am 1996;78:1646-57

©1996 by The Journal of Bone and Joint Surgery, Inc.

Fig. 3-B: Radiograph made after open reduction and internal fixation.

BRAD WYRSCH et al. J Bone Joint Surg Am 1996;78:1646-57

©1996 by The Journal of Bone and Joint Surgery, Inc.

Fig. 3-C: Radiograph made after most of the hardware had been removed because of deep infection that caused breakdown of the wound and sloughing of the skin.

BRAD WYRSCH et al. J Bone Joint Surg Am 1996;78:1646-57

©1996 by The Journal of Bone and Joint Surgery, Inc.

Fig. 3-D: Despite multiple débridements, a free flap, and the use of an Ilizarov device, a non-union developed in association with the infection.

BRAD WYRSCH et al. J Bone Joint Surg Am 1996;78:1646-57

©1996 by The Journal of Bone and Joint Surgery, Inc.

Fig. 3-E: A transtibial amputation was performed twenty months after the initial injury because of recurrent osteomyelitis and drainage from the wound.

BRAD WYRSCH et al. J Bone Joint Surg Am 1996;78:1646-57

©1996 by The Journal of Bone and Joint Surgery, Inc.