OTA 1997 Posters - Foot & Ankle Fractures

Reconstruction of Complex Distal Tibia Fracture with a 90 Degree Cannulated Blade Plate: A Preliminary Report

Steven J. Morgan, MD, Lane Shepherd, MD, David Thordarson, MD, Jackson Lee, MD

University of Southern California, School of Medicine, Los Angeles, California, USA

Purpose: Metaphyseal bone loss associated with tibial pilon fractures limits the use of standard internal fixation in fracture reconstruction. We suggest the use of an alternative internal fixation device for salvage ankle arthrodesis with metaphyseal bone loss, as well as a method of stable internal fixation for comminuted metaphyseal fractures and nonunions of the distal tibia.

Methods: Five patients were prospectively reviewed following reconstruction of a tibial pilon fracture with a cannulated blade plate. Three patients with C3 pilon fractures underwent salvage ankle fusion. One patient with an A3 open pilon fracture was converted from external fixation to internal fixation at the time of flap elevation and metaphyseal bone grafting. One patient with a metaphyseal nonunion following bone transport underwent compression plating. A Synthes 90 degree Titanium Cannulated Limited Contact Blade Plate was used in all cases. Placement of the implant was dictated by the conditions of the soft tissues. Two ankle fusions were performed by placing the plate posteriorly with the blade in the talar neck and body. The third arthrodesis plate was placed laterally into the talar body. Plate placement for the extra-articular fracture and nonunion was medial and posterior respectively with the blade placed in distal metaphyseal bone. Early range of motion was instituted following the stabilization of soft tissues. Progressive weight bearing was allowed at the time of bone consolidation.

Results: A stable arthrodesis and fracture healing was achieved in four cases. Implant failure occurred in one case. Average time to consolidation of fusion or fracture site was three months. Acceptable fusion position and fracture alignment was achieved in all cases. No soft tissue complications were related to the implant.

Discussion: Reconstruction of tibial pilon fractures is challenging. Significant metaphyseal bone loss prohibits use of standard internal fixation techniques for early salvage arthrodesis. The intact peri-articular bone, in extra-articular fractures and nonunions of the distal tibial metaphysis, is often too small and osteopenic to accept standard stable internal fixation. Reconstruction with bridging external fixation for prolonged periods may result in unacceptable soft tissue and joint complications. Blade plate fixation provides axial and rotational stability in situations that require distal fixation in small, and often osteopenic bone segments. Cannulation of the blade plate allows for precision placement of the implant over a guide wire. Stable internal fixation eliminates the need for prolonged external fixation and allows for early range of motion.

Conclusion: The 90 degree cannulated blade plate is a reasonable implant alternative in salvage ankle fusion of C3 tibial pilon fractures, and in the reconstruction of A3 tibial pilon fractures and nonunions.