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Arthroscopic assisted tibial plafond fracture fixation and bone graft: surgical technique
ESSKA Academy. Marsland D. Nov 8, 2019; 284429; epESMA-16 Topic: Arthroscopic Surgery
Mr. Daniel Marsland
Mr. Daniel Marsland
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Arthroscopic assisted tibial plafond fracture fixation and bone graft: surgical technique

ePoster - epESMA-16

Topic: Sports Trauma

Marsland D., Newman M.
Hampshire Hospitals NHS Foundation Trust, Trauma & Orthopaedics, Winchester, United Kingdom

Introduction: Tibial plafond fractures are high energy injuries caused by axial loading. They are challenging to manage given the frequency of soft tissue involvement and fracture comminution. As surgical techniques evolve, arthroscopic assisted fracture fixation is becoming more common, but with very limited evidence in the ankle.
Objectives: The purpose of the current study was to report the technique of arthroscopic assisted fracture fixation and bone graft augmentation in a patient with a high energy tibial plafond fracture.
Methods: A 51 year old male presented after being involved in a pedestrian versus car road traffic accident. He sustained a closed right tibial plafond fracture, associated with significant soft tissue swelling. Past medical history included Factor V Leiden. Plain radiographs showed a depressed tibial plafond fracture, confirmed on CT and MRI.
Anterior arthroscopy was performed (van Dijk technique) using dynamic traction when necessary, via standard anteromedial and anterolateral portals. After debridement of the fracture, an ACL drill guide was inserted, allowing drilling of an 8mm bone tunnel via the medial tibia, in line with the depressed articular fracture. A bone graft impactor was then used to reduce the fracture, confirmed under direct vision arthroscopically and with fluoroscopy. The metaphyseal bone defect was then filled with synthetic bone graft via the bone tunnel. Finally, a 4.0mm cannulated screw was inserted along the physeal scar as a raft screw, to prevent late displacement of the fracture. Post operatively, the patient was managed non-weight bearing for 6 weeks but allowed to do early in line range of motion exercises.
Results: There were no wound or venous thromboembolism complications post-operatively. Radiographs at 12 weeks showed the fracture had united and the articular surface remained congruent with no evidence of late displacement. At 6 months the patient reported being pain free on weight bearing. Range of motion was slightly restricted to dorsiflexion of 10 degrees and plantar flexion of 30 degrees.
Conclusion: The current report shows that arthroscopic assisted tibial plafond fixation is safe, technically feasible and has the benefit of allowing accurate fracture reduction whilst minimising soft tissue disruption. We recommend further research is conducted to determine the long term outcomes of such techniques, especially with regards to secondary osteoarthritis and function.
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