الفهرس 
Anatomy, Biomechanics and Mechanism of the fractureOnly 14 pages are availabe for public view
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Abstract
In this study , the two stages protocol is proposed as a wise, safe and ideal protocol in treating most types of tibial plafond fractures.
A three dimentional C.T. scan which is made post ligamentotaxis by a triangular fixator is a smart way to delineate the fracture pattern, to consider the approach and the plan for surgery.
The triad of Span-Scan-Plan is favourable in this complicated fracture.
Key points
- To be considered a tibial plafond fracture, there must be a fracture line traversing the weight-bearing articular surface of the distal tibia.
- Plafond fractures occurring from rotational forces have a much greater chance of having a good clinical outcome compared with ones from an axial load.
- Classical open reduction internal fixation remains the method of choice for Ruedi type I injuries with minimal soft-tissue trauma given that surgery is carried out by experts within 4-6 h of the injury.
- A failure to respect the soft tissues will result in unacceptable results in internal fixation.
- In Ruedi type III injuries a worse prognosis is inevitable. Cases must be assessed on an individual basis and a treatment pathway meticulously planned out in advance. They are best dealt with by limited internal fixation and hybrid external fixation.
- Traction and early motion will not give such good results as either open reduction or internal fixation or the use of an external fixator in experienced hands. However, traction and early motion is a very safe option and remains the method of choice in developing countries.
- This fracture is rare and the complications are related directly to the surgical treatment given to the patient this fracture is not appropriate for treatment by surgical trainees unless working under direct supervision.
- There are many concepts of treatment that are still under trials but give a great hope that one day treatment of pilon fracture will be more easy and have better outcome
- Finally it must be accepted that some fractures are unfixable. These fractures will inevitably be treated by an arthrodesis which is best delayed until soft tissue conditions are optimum.