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Online ISSN 1827-1707
Dirschl R. D.
Department of Orthopaedics University of North Carolina School of Medicine Chapel Hill, NC, USA
Fractures of the tibial plafond are severe, high energy injuries; successful management of these injuries requires particular attention to the soft tissue injury. Failure to carefully manage the soft tissue injury will lead to a high rate of wound complications, deep infections, and even amputation. Treatment techniques for the tibial plafond fracture have changed considerably over the years, primarily due to the high rates and severe consequences of complications following immediate open reduction and internal fixation. Modern treatment techniques involve a period of spanning external fixation, followed by delayed internal fixation with or without continuation of the external fixator. There is as yet no conclusive evidence in the literature as to whether internal fixation with removal of the external fixator or limited internal fixation with continuation of the external fixator gives superior results. It is possible that outcomes may depend on factors beyond the surgeon’s control, such as the extent of soft tissue injury, the extent of articular cartilage damage, or patient related factors.