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 Foot and Ankle Test 1: Trauma about the Foot and Ankle
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The Journal of Bone and Joint Surgery (American) 85:287-295 (2003)
© 2003 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

Tibial Plafond Fractures

How Do These Ankles Function Over Time?

J. Lawrence Marsh, MD, Dennis P. Weigel, MD and Douglas R. Dirschl, MD

Investigation performed at the Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, College of Medicine, Iowa City, Iowa, and WakeMed Center, Raleigh, North Carolina
J. Lawrence Marsh, MD
Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, College of Medicine, 01071 JPP, 200 Hawkins Drive, Iowa City, IA 52242-1088. E-mail address: j-marsh{at}uiowa.edu

Dennis P. Weigel, MD
Alexandria Orthopaedics, 1500 Irving Street, Alexandria, MN 56308

Douglas R. Dirschl, MD
Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, 3181 S.W. Sam Jackson Park Road, OP31, Portland, OR 97239. E-mail address: dirschld@ohsu.edu

One or more of the authors received grants or outside funding in support of the research or preparation of this manuscript (National Institute of Arthritis and Musculoskeletal and Skin Diseases grant AR 48939 and funds from the Orthopaedic Research and Education Foundation). They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

A video supplement to this article is available from the Video Journal of Orthopaedics. A video clip is available at the JBJS web site, www.jbjs.org. The Video Journal of Orthopaedics can be contacted at (805) 962-3410, web site: www.vjortho.com.

Background: The intermediate outcome of fractures of the tibial plafond treated with current techniques has not been reported, to our knowledge. The purpose of this study, performed at a minimum of five years after injury, was to determine the effect of these fractures on ankle function, pain, and general health status and to determine which factors predict favorable and unfavorable outcomes.

Methods: Fifty-six ankles (fifty-two patients) with a tibial plafond fracture were treated with a uniform technique consisting of application of a monolateral hinged transarticular external fixator coupled with screw fixation of the articular surface. Thirty-one patients with thirty-five involved ankles returned between five and twelve years after the injury for a physical examination, assessment of ankle pain and function with the Iowa Ankle Score and Ankle Osteoarthritis Scale, assessment of general health status with the Short Form-36 (SF-36), and radiographic examination of the ankle.

Results: Arthrodesis had been performed on five of the forty ankles for which the outcome was known at a minimum of five years after the injury. Other than removal of prominent screws (two patients), no other surgical procedure had been performed on any patient. The average Iowa Ankle Score was 78 points (range, 28 to 96 points). The scores on the SF-36 and Ankle Osteoarthritis Scale demonstrated a long-term negative effect of the injury on general health and on ankle pain and function when compared with those parameters in age-matched controls. The degree of osteoarthrosis was grade 0 in three ankles, grade 1 in six, grade 2 in twenty, and grade 3 in six. The majority of patients had some limitation with regard to recreational activities, with an inability to run being the most common complaint (twenty-seven of the thirty-one patients). Fourteen patients changed jobs because of the ankle injury. Fifteen ankles were rated by the patient as excellent; ten, as good; seven, as fair; and one, as poor. Nine patients with previously recorded ankle scores had better scores after the longer follow-up interval. The patients perceived that their condition had improved for an average of 2.4 years after the injury.

Conclusions: Although tibial plafond fractures have an intermediate-term negative effect on ankle function and pain and on general health, few patients require secondary reconstructive procedures and symptoms tend to decrease for a long time after healing.

Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.



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