Tibial Plafond Fractures Type C: Open Reduction and Internal Fixation versus External Fixation by Ilizarov: (A Systematic Review)
Authors: Nor El-Din Muhamed Salah El-Din , El-Gebeily Mohamed Abd El-Moneim , El-Sayed Amr Amal 
Published: November 2024

Abstract

Background
Tibial Plafond Fractures affect weight-bearing articular surface and comprise &lt; 1% of all lower extremity fractures. Such fractures are due to rotational or axial-loading forces as a result of high-energy trauma. Plafond means ceiling or dome. The Talus has tibial plafond as a dome or ceiling and articulates with the distal tibia with its smooth surface. Rotational force may produce spiral fractures; it may be extra-articular or intra-articular. Usually, rotational forces produce less soft tissue injuries whereas axial compressive forces produce intra-articular fractures with more soft tissue injuries.

Aim of the Work
to compare open reduction internal fixation (ORIF) and external fixation by Ilizarov in patients with pilon fracture type C and to clarify which method is better in terms of reduction and union results and major complications.

Patients and Methods
After ethical committee approval, this Systematic review was conducted on Patients aged with 18 years or older with tibial plafond fractures of type C according to the AO/OTA classification including Studies and published papers between January 2000 and January 2022. This systematic review was conducted on human subjects in different literatures collected from different medical websites between January 2000 and January 2022 in which we involved clinical and/or functional outcomes in ORIF versus Ilizarov fixation for operative treatment of tibial plafond fracture type C according to the AO/OTA classification with follow up period of at least 6 months. Five Studies literature (Four retrospective and one Prospective) that involved 250 patients, fulfilled the study criteria and were included in this study.

Results
As regards the time till surgery and healing, the current systematic review revealed that there was statistically significant increase in the time till surgery (days) in ORIF group (11.75 ± 2.67) versus EF group (6.95 ± 3.14) (p-value &lt;0.001) and non-significant increase in the time to union (days) in ORIF group (48.10 ± 44.11) than EF group (41.73 ± 37.53) (p-value = 0.287). The current study results revealed that the Range of Ankle Motion showed a statistically significant increase in the mean dorsiflexion and plantarflexion in ORIF group than EF group (p- value &lt;0.001). As regards complications, Analysis of the complications (nonunion, malunion, superficial, deep infections, Osteomyelitis and Arthritis) revealed a statistically significant increase in the percentage of patients with complications in EF group compared to ORIF group (p value &lt;0.001) with significant difference in rates of malunion (p = 0.034) and superficial infection (p = 0.012) between ORIF and EF for treatment of TPF. Although the risk of deep infection was higher in the EF group, it was not found to be statistically significant (p = 0.811).

Conclusion
this study provides an overview of functional outcome and complications after common surgical strategies for management of tibial plafond fractures. Both ORIF and CEF are acceptable treatment options for management of TPF; however, functional levels vary substantially. External fixation results in the higher rate complications of malunion, superficial infection and decreased range of motion compared to Open reduction and internal fixation, while Open reduction and internal fixation was associated with significant bad functional outcome and delayed time to healing and surgery. Post-traumatic arthritis deep infection and non-union rates were comparable in both groups. The results reported here can aid patients and their surgeons in the decision for operative treatment.