Operative Treatment of Fractures of the Tibial Plafond. A Randomized, Prospective Study* by BRAD...
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Transcript of Operative Treatment of Fractures of the Tibial Plafond. A Randomized, Prospective Study* by BRAD...
![Page 1: Operative Treatment of Fractures of the Tibial Plafond. A Randomized, Prospective Study* by BRAD WYRSCH, MARK A. MCFERRAN, MARK MCANDREW, THOMAS J. LIMBIRD,](https://reader035.fdocuments.us/reader035/viewer/2022081514/5697bf981a28abf838c9155b/html5/thumbnails/1.jpg)
Operative Treatment of Fractures of the Tibial Plafond. A Randomized, Prospective Study*
by BRAD WYRSCH, MARK A. MCFERRAN, MARK MCANDREW, THOMAS J. LIMBIRD, MARION C. HARPER, KENNETH D. JOHNSON, and HERBERT S.
SCHWARTZ
J Bone Joint Surg AmVolume 78(11):1646-57
November 1, 1996
©1996 by The Journal of Bone and Joint Surgery, Inc.
![Page 2: Operative Treatment of Fractures of the Tibial Plafond. A Randomized, Prospective Study* by BRAD WYRSCH, MARK A. MCFERRAN, MARK MCANDREW, THOMAS J. LIMBIRD,](https://reader035.fdocuments.us/reader035/viewer/2022081514/5697bf981a28abf838c9155b/html5/thumbnails/2.jpg)
Figs. 1-A through 1-E: Case 4, a sixteen-year-old girl who sustained a closed type-I fracture of the tibial plafond in a motor-vehicle accident.
BRAD WYRSCH et al. J Bone Joint Surg Am 1996;78:1646-57
©1996 by The Journal of Bone and Joint Surgery, Inc.
![Page 3: Operative Treatment of Fractures of the Tibial Plafond. A Randomized, Prospective Study* by BRAD WYRSCH, MARK A. MCFERRAN, MARK MCANDREW, THOMAS J. LIMBIRD,](https://reader035.fdocuments.us/reader035/viewer/2022081514/5697bf981a28abf838c9155b/html5/thumbnails/3.jpg)
Figs. 1-A through 1-E: Case 4, a sixteen-year-old girl who sustained a closed type-I fracture of the tibial plafond in a motor-vehicle accident.
BRAD WYRSCH et al. J Bone Joint Surg Am 1996;78:1646-57
©1996 by The Journal of Bone and Joint Surgery, Inc.
![Page 4: Operative Treatment of Fractures of the Tibial Plafond. A Randomized, Prospective Study* by BRAD WYRSCH, MARK A. MCFERRAN, MARK MCANDREW, THOMAS J. LIMBIRD,](https://reader035.fdocuments.us/reader035/viewer/2022081514/5697bf981a28abf838c9155b/html5/thumbnails/4.jpg)
Fig. 1-C: Anteroposterior radiograph made after open reduction and internal fixation.
BRAD WYRSCH et al. J Bone Joint Surg Am 1996;78:1646-57
©1996 by The Journal of Bone and Joint Surgery, Inc.
![Page 5: Operative Treatment of Fractures of the Tibial Plafond. A Randomized, Prospective Study* by BRAD WYRSCH, MARK A. MCFERRAN, MARK MCANDREW, THOMAS J. LIMBIRD,](https://reader035.fdocuments.us/reader035/viewer/2022081514/5697bf981a28abf838c9155b/html5/thumbnails/5.jpg)
Figs. 1-D and 1-E: Anteroposterior and lateral radiographs made two years after the injury.
BRAD WYRSCH et al. J Bone Joint Surg Am 1996;78:1646-57
©1996 by The Journal of Bone and Joint Surgery, Inc.
![Page 6: Operative Treatment of Fractures of the Tibial Plafond. A Randomized, Prospective Study* by BRAD WYRSCH, MARK A. MCFERRAN, MARK MCANDREW, THOMAS J. LIMBIRD,](https://reader035.fdocuments.us/reader035/viewer/2022081514/5697bf981a28abf838c9155b/html5/thumbnails/6.jpg)
Figs. 1-D and 1-E: Anteroposterior and lateral radiographs made two years after the injury.
BRAD WYRSCH et al. J Bone Joint Surg Am 1996;78:1646-57
©1996 by The Journal of Bone and Joint Surgery, Inc.
![Page 7: Operative Treatment of Fractures of the Tibial Plafond. A Randomized, Prospective Study* by BRAD WYRSCH, MARK A. MCFERRAN, MARK MCANDREW, THOMAS J. LIMBIRD,](https://reader035.fdocuments.us/reader035/viewer/2022081514/5697bf981a28abf838c9155b/html5/thumbnails/7.jpg)
Figs. 2-A through 2-D: Case 22, a fifty-year-old man who sustained an open type-III fracture of the tibial plafond in a fall from a tree stand.
BRAD WYRSCH et al. J Bone Joint Surg Am 1996;78:1646-57
©1996 by The Journal of Bone and Joint Surgery, Inc.
![Page 8: Operative Treatment of Fractures of the Tibial Plafond. A Randomized, Prospective Study* by BRAD WYRSCH, MARK A. MCFERRAN, MARK MCANDREW, THOMAS J. LIMBIRD,](https://reader035.fdocuments.us/reader035/viewer/2022081514/5697bf981a28abf838c9155b/html5/thumbnails/8.jpg)
Fig. 2-B: Anteroposterior radiograph made after immediate débridement followed by limited internal fixation and placement of an external fixator.
BRAD WYRSCH et al. J Bone Joint Surg Am 1996;78:1646-57
©1996 by The Journal of Bone and Joint Surgery, Inc.
![Page 9: Operative Treatment of Fractures of the Tibial Plafond. A Randomized, Prospective Study* by BRAD WYRSCH, MARK A. MCFERRAN, MARK MCANDREW, THOMAS J. LIMBIRD,](https://reader035.fdocuments.us/reader035/viewer/2022081514/5697bf981a28abf838c9155b/html5/thumbnails/9.jpg)
Fig. 2-C: Anteroposterior radiograph made eleven months postoperatively, demonstrating union with moderate narrowing of the joint space.
BRAD WYRSCH et al. J Bone Joint Surg Am 1996;78:1646-57
©1996 by The Journal of Bone and Joint Surgery, Inc.
![Page 10: Operative Treatment of Fractures of the Tibial Plafond. A Randomized, Prospective Study* by BRAD WYRSCH, MARK A. MCFERRAN, MARK MCANDREW, THOMAS J. LIMBIRD,](https://reader035.fdocuments.us/reader035/viewer/2022081514/5697bf981a28abf838c9155b/html5/thumbnails/10.jpg)
Anteroposterior and lateral radiographs made at twenty-nine months.
BRAD WYRSCH et al. J Bone Joint Surg Am 1996;78:1646-57
©1996 by The Journal of Bone and Joint Surgery, Inc.
![Page 11: Operative Treatment of Fractures of the Tibial Plafond. A Randomized, Prospective Study* by BRAD WYRSCH, MARK A. MCFERRAN, MARK MCANDREW, THOMAS J. LIMBIRD,](https://reader035.fdocuments.us/reader035/viewer/2022081514/5697bf981a28abf838c9155b/html5/thumbnails/11.jpg)
Figs. 3-A through 3-E: Anteroposterior radiographs of Case 10, a thirty-five-year-old man who sustained a closed type-I fracture of the tibial plafond in a motor-vehicle accident.
BRAD WYRSCH et al. J Bone Joint Surg Am 1996;78:1646-57
©1996 by The Journal of Bone and Joint Surgery, Inc.
![Page 12: Operative Treatment of Fractures of the Tibial Plafond. A Randomized, Prospective Study* by BRAD WYRSCH, MARK A. MCFERRAN, MARK MCANDREW, THOMAS J. LIMBIRD,](https://reader035.fdocuments.us/reader035/viewer/2022081514/5697bf981a28abf838c9155b/html5/thumbnails/12.jpg)
Fig. 3-B: Radiograph made after open reduction and internal fixation.
BRAD WYRSCH et al. J Bone Joint Surg Am 1996;78:1646-57
©1996 by The Journal of Bone and Joint Surgery, Inc.
![Page 13: Operative Treatment of Fractures of the Tibial Plafond. A Randomized, Prospective Study* by BRAD WYRSCH, MARK A. MCFERRAN, MARK MCANDREW, THOMAS J. LIMBIRD,](https://reader035.fdocuments.us/reader035/viewer/2022081514/5697bf981a28abf838c9155b/html5/thumbnails/13.jpg)
Fig. 3-C: Radiograph made after most of the hardware had been removed because of deep infection that caused breakdown of the wound and sloughing of the skin.
BRAD WYRSCH et al. J Bone Joint Surg Am 1996;78:1646-57
©1996 by The Journal of Bone and Joint Surgery, Inc.
![Page 14: Operative Treatment of Fractures of the Tibial Plafond. A Randomized, Prospective Study* by BRAD WYRSCH, MARK A. MCFERRAN, MARK MCANDREW, THOMAS J. LIMBIRD,](https://reader035.fdocuments.us/reader035/viewer/2022081514/5697bf981a28abf838c9155b/html5/thumbnails/14.jpg)
Fig. 3-D: Despite multiple débridements, a free flap, and the use of an Ilizarov device, a non-union developed in association with the infection.
BRAD WYRSCH et al. J Bone Joint Surg Am 1996;78:1646-57
©1996 by The Journal of Bone and Joint Surgery, Inc.
![Page 15: Operative Treatment of Fractures of the Tibial Plafond. A Randomized, Prospective Study* by BRAD WYRSCH, MARK A. MCFERRAN, MARK MCANDREW, THOMAS J. LIMBIRD,](https://reader035.fdocuments.us/reader035/viewer/2022081514/5697bf981a28abf838c9155b/html5/thumbnails/15.jpg)
Fig. 3-E: A transtibial amputation was performed twenty months after the initial injury because of recurrent osteomyelitis and drainage from the wound.
BRAD WYRSCH et al. J Bone Joint Surg Am 1996;78:1646-57
©1996 by The Journal of Bone and Joint Surgery, Inc.