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Osteochondral autograft transplantation in the treatment of AO/OTA type C3 tibial plafond fractures with irreducibly comminuted area and/or cartilage delamination in the distal tibial facet

Published:January 25, 2022DOI:https://doi.org/10.1016/j.injury.2022.01.040

      Highlights

      • True non-reconstructable comminution with irreducible tiny fragments and/or cartilage delamination was most likely to present in bordering zones between the major fragments where the violence concentrated.in AO OTA type C3 tibial plafond fractures.
      • “Extensive comminution and over 50% of cartilage impaction into the distal tibial metaphysis” did not necessarily mean that the entire comminuted and impacted zone was irreparable with ORIF. On the contrary, in the majority of patients, most part of the plafond was still reparable with ORIF.
      • The reparability of these main fragments of the plafond and metaphysis and focalization of the comminuted zones gave a chance to repair them with osteochondral autograft transplantation to restore the congruity of the facet.
      • Osteochondral autograft transplantation together with meticulous reduction and fixation may provide a chance to relieve pain without sacrificing the joint in young patients suffering AO OTA type C3 tibial plafond fractures with irreducibly comminuted area and/or cartilage delamination.

      Abstract

      Introduction

      Tibial plafond fractures, especially the AO/OTA type C3 ones that take place in young patients with excessive facet fragmentation and cartilage loss that preclude anatomical reduction and effective internal fixation, are devastating situations that often subject to primary arthrodesis. The aim of the current study is to introduce a joint preserving technique by using osteochondral autograft to treat such difficult cases and to evaluate its short-term outcome.

      Methods

      A total of 11 patients suffering AO-OTA type C3 tibial plafond fractures with irreparable area treated with osteochondral autograft and ORIF, with an average follow-up period of 34 months, were analyzed. Visual analogue scale (VAS), short-form 36 (SF-36), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, and ankle range of motion (ROM) were assessed for functional outcome evaluation. The weight-bearing AP and lateral radiograph, as well as CT reconstructive images were examined to evaluate bony union and the occurrence of post-traumatic arthritis.

      Results

      At the final follow-up, the mean VAS scale was 2.2. The mean AOFAS and SF-36 scores were 86.3 and 84.5 respectively. Among all the included patients, 8 achieved both AOFAS and SF-36 scores above 80. The average ankle range of motion was 29.9°. No infection, compartment syndrome, post-traumatic arthrosis or donor site pain was noted in the current study. No patient received secondary ankle arthrodesis at the end of the follow-up.

      Conclusions

      Although primary ankle arthrodesis is an effective method, routine ankle arthrodesis should be carried out with second thoughts in patients, especially patients with relatively young age, suffering AO-OTA type C3 tibial plafond fractures with irreducible area. On the other hand, osteochondral autograft transplantation may provide a chance to relieve pain without sacrificing the joint.

      Keywords

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