| Article ID | Journal | Published Year | Pages | File Type |
|---|---|---|---|---|
| 4288733 | International Journal of Surgery Case Reports | 2016 | 5 Pages |
•Tibial plafond fractures carry a high risk for post-traumatic osteoarthritis.•Tricortical iliac crest autologous bone grafting (TCG) avoided need for arthrodesis.•TCG with internal fixation restored joint stability, congruency and alignment.•TCG should be considered for whom biological restoration is feasible.
IntroductionThe risk for post-traumatic osteoarthritis (POA) following tibial plafond joint trauma has been reported to be as high as 70–75%. In the treatment of more severe joint pathologies, with incongruity and intra-articular defects, internal or external fixations techniques may be required.Presentation of caseWe report the orthopedic management of a pilon fracture in a 30-year-old male with malunion and implant failure after initial mal-reduction of the fracture 9-months earlier. Tricortical iliac crest autologous bone grafting (TCG) was used in combination with internal fixation to restore distal tibial articular. The procedure resulted in a pain free ankle, sufficient range of motion for function and patient satisfaction.DiscussionEarly surgical intervention and anatomical reduction with appropriate fixation are recommended for intra-articular tibial pilon fractures. Autogenous bone grafting is a reliable treatment option to augment structural stability, bone defects and bone-healing. Indications for bone grafting include delayed union or nonunion, malunion, arthrodesis, limb salvage, and reconstruction of bone voids or defects. The application of TCG in the management of a malreduced tibial plafond fracture has not been described before.ConclusionWe performed TCG with internal fixation in order to restore stability, congruency and alignment in a young patient in whom a biological restoration was feasible due to good bone quality. In suitable cases, TCG might provide an alternative to arthrodesis or arthroplasty.
