Posterior Blade Plate Fusion: A Salvage Procedure in Severe Posttraumatic Osteoarthritis of the Tibiotalar Joint

The treatment of tibial plafond fractures is challenging and often is complicated by the compromise of the anterior ankle soft-tissue envelope and a high degree of fracture comminution. Many of these injuries are nonreconstructable and posttraumatic osteoarthritis of the tibiotalar joint is unavoidable. These patients may benefit from a salvage procedure using a posterior blade plate fusion of the tibiotalar joint. This procedure avoids the compromised anterior ankle soft-tissue envelope and allows simultaneous reconstruction of the metaphyseal defect as well as fusion of the tibiotalar joint. Indications include the acute treatment of severely comminuted tibial plafond fractures that appear nonreconstructable, management of posttraumatic tibiotalar osteoarthritis that is associated with significant compromise of the anterior ankle soft tissue envelope, and salvage of distal metaphyseal nonunions or delayed unions that are associated with posttraumatic tibiotalar osteoarthritis. We suggest posterior blade plate fusion as a standard procedure for these patient populations. Further clinical trials are required to investigate the clinical long-term outcomes in these patients.