van Bergen Peter A.J. The aim of our study was to evaluate clinical and MRI outcomes following arthroscopic treatment of distal tibia osteochondral lesions and to report our results with treating … Intra-articular fractures of the tibial plafond (pilon fractures) are among the most challenging of orthopaedic problems. A systematic review, Return to sport activities after medial displacement calcaneal osteotomy and flexor digitorum longus transfer, Arthroscopic treatment of osteochondral defects of the talus: outcomes at eight to twenty years of follow-up, Correlation of SF-36 and SF-12 component scores in patients with diabetic foot disease. stable fracture patterns without articular surface displacement; critically ill or nonambulatory patients; significant risk of skin problems (diabetes, vascular disease, neuropathy) technique . 2017 Oct;34(4):471-487. doi: 10.1016/j.cpm.2017.05.005. We introduce a technique of arthroscopic antegrade cancellous bone autotransplantation; fibrocartilage regeneration … Another approach is posterior ankle arthroscopy with inspection of the cartilage and removal of any detached cartilage. Treatment is often surgical if the fracture is displaced. Osteochondral lesions of the distal tibial plafond (OLTP) are rare and far less common than osteochondral lesions of the talus. These fractures make up 5% to 7% of all tibial fractures. Simply select your manager software from the list below and click on download. Treatment of a distal tibial osteochondral lesion with a synthetic osteochondral plug: a case report. 2009;30(9):900–3. eCollection 2019 Aug. Functional and MRI outcomes after arthroscopic microfracture for treatment of osteochondral lesions of the distal tibial plafond. (1,2) Approximately 2.6% of isolated OCLs of the ankle occur in the distal tibial plafond (OCLTP), equivalent to a 14:1 or 20:1 ratio of talar:tibial … Between October 2010 and November 2011, a consecutive series of 27 patients, 15 males and 12 females, were treated arthroscopically with the one-step BMDCT for OLTPs. The posterior intersection between the medial malleolus and tibial plafond is identified using an arthroscopic hook . Fractures of the distal tibial plafond are also termed pilon fractures to describe the high energy axial compression force of the tibia as it acts as a pestle, driving vertically into the talus. USA.gov. In a recent study, CT … View or download all the content the society has access to. After 2 screw holes are predrilled and tapped in the medial malleolus, a medial malleolar osteotomy is created while 2 retractors protect the anterior and posterior structures ( Fig. Background: The aim of this study was to evaluate the incidence and morphologic characteristics of osteochondral lesions of the distal tibial plafond (OLTP) by location and morphologic characteristics on MRI. Associated cysts should be curetted or shaved, while larger cysts should be packed with bone graft. If the lesion is stable (without loose pieces of cartilage or bone) and if symptoms are mild conservative treatment may be … Surgical treatment of transchondral talar-dome fractures (osteochondritis dissecans). Epub 2017 Jun 2. American Orthopaedic Foot & Ankle Society, Clinical Outcomes of Osteochondral Lesions of the Tibial Plafond Following Arthroscopic Microfracture, Athanasiou, KA, Niederauer, GG, Schenck, RC. Chart review revealed that all subjects had ankle pain at time of MRI examination. Sign in using your membership username and password.  |  Find out about Lean Library here, If you have access to journal via a society or associations, read the instructions below. long leg cast for 6 weeks followed by fracture brace and ROM exercises; alternative treatment is with early ROM; outcomes. Methods: Results: Cast Treatment of Tibial Fractures - Indication for Closed Treatment: - indications -- These are based on "personality" of the fracture as described by Nicoll EA (1964) - he listed factors favoring union: - displacement: if the fracture fragments on are or can be opposed to 25% in a transverse fracture, casting or bracing is permissible - more than 50% initial frx … Though all the patients in this study were able to return to sports activity … The treatment method involved stabilization by the diaphyseal-epiphyseal Ilizarov technique of external fixation. 2018. Osteochondral Lesions of the Talus Classification Systems Feat. (b, c) Sagittal fluid-sensitive MR images are showing a superior talar neck (arrows) and anterior tibial osteophytes (dashed arrows) in a male with anterior ankle impingement symptoms. the site you are agreeing to our use of cookies. Remove as few cartilage … Surgery attempts to restore the shattered bone back to its original position. The Ilizarov external fixator (Smith & Nephew, Richards Inc., Memphis, TN) did not cross the tibial-talar joint. A radiograph and MRI is shown in Figures A and B. View or download all content the institution has subscribed to. The talus has no muscular or tendinous attachments and receives much of its blood supply through its neck via … A topographic study was also performed. 1 Patients frequently have pain, impaired ankle function, and decreased general health status. This is a retrospective study of the radiographs, hospital charts, and clinic charts of 12 patients with 13 pilon fractures who were treated by the senior authors between 1989 and 1992 at their institution. The appropriate treatment for osteochondral injury of the tibial plafond is unclear. This site uses cookies. Mosaicplasty of the … Bone grafting is usually performed in an … Intra-articular fractures of the tibial plafond (pilon fractures) are among the most challenging of orthopaedic problems. The loose piece of bone and cartilage may migrate into the joint causing instability, pain, or locking. Also in this case the T2 MRI images demonstrate bonemarrow oedema mainly between the fragment and the tibia as a sign … Miska, M, Wiewiorski, M, Valderrabano, V. Moktassi, A, Popkin, CA, White, LM, Murnaghan, ML. Clin Podiatr Med Surg. If you bring the ankle in forced plantar flexion you will see the defect. immobilization. [Source 19)] Anteromedial … The latter option … Laszlo Hangody ... Osteochondral Lesions of the Tibial Plafond / Distal Tibia ... International Congress on Cartilage Repair of the Ankle. Arthrosc Tech. If treatment refractory, consider increasing the intensity of EX/RP and/or level of care (i.e., intensive outpatient care, residential EX/RP program); somatic therapies (transcranial magnetic stimulation); or neurosurgical interventions (deep brain stimulation [DBS] or ablative procedures). We report the imaging characteristics of osteochondritis dissecans of the tibial articular surface (tibial plafond). Please check you selected the correct society from the list and entered the user name and password you use to log in to your society website. de Leeuw C. Niek van Dijk Revue de Chirurgie Orthopédique et Réparatrice de l’Appareil Moteur 2008;94(8 Suppl):635-646. The Evolution of ACI for Surgical Treatment … 27443_van Bergen.indd 21 27-11-13 09:23. In case of persisting pain you could perform retrograde drilling in order to stimulate the healing of the fragment. steochondral lesions of the distal tibial plafond are rare—far less common than osteochondral lesions of the talus1-4. Treatment of osteochondral defects of the talus Christiaan J.A. CONCLUSION: Osteochondritis dissecans of the tibial plafond … 2B ). Non Surgical Treatment Treatment depends on the severity of the OCD lesion. … Unfallchirurg. They had 9 patients … Usuelli, FG, Di Silvestri, CA, D’Ambrosi, R, Maccario, C, Tan, EW. long leg cast for 6 weeks followed by fracture brace and ROM exercises; alternative treatment … CONCLUSION. Ankle; BMDCT; Cartilage; OLTP; Osteochondral lesions. Some society journals require you to create a personal profile, then activate your society account, You are adding the following journals to your email alerts, Did you struggle to get access to this article? J. Deland 09:58. International Congress on Cartilage Repair of the Ankle. The optimum treatment of this fracture remains controversial, as retrospective reviews of the results of open reduction and … There were also improvements in the SF-12 score, from 36.3 (range, 23.3-55.1) preoperatively to 46.0 (range, 18.9-56.6) postoperatively for the SF-12 PCS, and from 41.3 (range, 14.2-65.0) preoperatively to 52.6 (range, 32.8-60.8) postoperatively for the SF-12 MCS. There are two types of treatment: non-operative and operative.Non-operative treatment may be appropriate for patients with an incidental finding of OCD on x-ray. Treatment Strategy and Surgical Approach for OCD of the Talus Feat. indications. The level of sports activity after the surgery was significantly lower than their level before the surgery (P = .012). The aim of our study was to evaluate clinical and MRI outcomes following arthroscopic treatment of distal tibia osteochondral lesions and to report our results with treating these rare lesions. The knee is the most commonly affected joint. Long-term follow-up, Biomechanical topography of human ankle cartilage, Bone-cartilage transplantation from the ipsilateral knee for chondral lesions of the talus, Osteochondritis dissecans of the tibial plafond: imaging characteristics and a review of the literature, Distal tibial osteochondral lesion treated with osteochondral allografting: a case report, Comparison of clinical outcomes between arthroscopic subchondral drilling and microfracture for osteochondral lesions of the talus, The minimal clinically important difference in the Oxford Knee Score and Short Form 12 score after total knee arthroplasty, Arthroscopic treatment of osteochondral lesions of the tibial plafond, Outcome of arthroscopic debridement and microfracture as the primary treatment for osteochondral lesions of the talar dome, Osteochondral lesions of the distal tibial plafond: localization and morphologic characteristics with an anatomical grid, Osteochondral lesions of the talus: localization and morphologic data from 424 patients using a novel anatomical grid scheme, Chronic lateral instability: arthroscopic findings and long-term results, Osteochondral transplantation of autologous graft for the treatment of osteochondral lesions of talus: 5- to 7-year follow-up, Osteoarticular grafts in the treatment of OCD of the talus: mosaicplasty versus autologous chondrocyte transplantation, Outcomes are favorable after arthroscopic treatment of osteochondritis dissecans of the talus, Osteochondral defects in the human knee: influence of defect size on cartilage rim stress and load redistribution to surrounding cartilage, The validity of the quick-FAAM in patients seeking treatment for an acute or subacute foot or ankle health condition, Arthroscopic management of osteochondritis dissecans of the capitellum: mid-term results in adolescent athletes, Treatment of talus osteochondral defects in chronic lateral unstable ankles: small-sized lateral chondral lesions had good clinical outcomes, Evidence of validity for the Foot and Ankle Ability Measure (FAAM), Reconstruction of a large osteochondral lesion of the distal tibia with an iliac crest graft and autologous matrix-induced chondrogenesis (AMIC): a case report, Cartilage transplantation techniques for talar cartilage lesions, Arthroscopic treatment of osteochondral lesions of the distal tibia, Treatment of a distal tibial osteochondral lesion with a synthetic osteochondral plug: a case report, Long-term results of microfracture in the treatment of talus osteochondral lesions, Natural progression of osteo-chondral defect in the femoral condyle, Functional and MRI outcomes after arthroscopic microfracture for treatment of osteochondral lesions of the distal tibial plafond, Measurement properties of the most commonly used Foot- and Ankle-Specific Questionnaires: the FFI, FAOS and FAAM. - Outcome Following Open Reduction and Internal Fixation of Open Pilon Fractures - The Sequential Recovery of Health Status after Tibial Plafond Fractures - Exam: - soft tissue: note presence of swelling and any fracture blisters; - perform an Allen test using a pulse oximeter for the foot vasculature (pulse ox is placed on the toe); - … Osteochondral lesions of the distal tibial plafond (OLTPs) are an uncommon problem. Treatment strategies for tibial hemimelia date as far back as 1877. Supplementary data. treatment of posterior pilon variant fracture Yukai Wang, Jianwei Wang* and Cong feng Luo Abstract Background: Posterior pilon variant fracture is a recently described posterior malleolus fracture characterized by the involvement of both posterolateral and posteromedial malleolar fragment. 10 In 1950, Bonin chose the term tibial plafond fracture to denote a fracture of the vault or ceiling of the ankle … Once candidates for treatment have been screened, treatment proceeds according to the lesion's location. Hoch, JM, Legner, JL, Lorete, C, Hoch, MC. The anterior tibial (dorsalis pedis), posterior tibial, and peroneal arteries contribute to the blood supply of the talus. J Bone Joint Surg Am. M. Easley 11:10. The presence of a tibia anlage, quadriceps … Very interesting case of a typical Osteochondritis Dissecans in the posterior tibial plafond. The aim of our study was to evaluate clinical and MRI outcomes following arthroscopic treatment of distal tibia osteochondral lesions and to report our results with treating … The bone of the lower part of the ankle joint (talus) is driven into the top of the ankle joint, causing a fracture to the weight bearing portion of the ankle joint (tibial plafond) and the distal tibia (and possibly fibula). Abstract and Figures Background: Osteochondral lesions (OCLs) of the tibial plafond (OLTPs) are rare, and few studies provide treatment recommendations. Three of the patients described in the literature underwent surgery, curettage of subchondral cyst with bone graft [ 4 ] or … The purpose of this study was to evaluate clinical outcomes following arthroscopic treatment of OLTPs. Salvage technique for treatment of periplafond tibial … AOFAS members have access to this journal as part of their membership. stable fracture patterns without articular surface displacement; critically ill or nonambulatory patients; significant risk of skin problems (diabetes, vascular disease, neuropathy) technique. All patients were evaluated through X-rays; MRI was performed preoperatively and at the final follow-up with MOCART score; clinical evaluation was assessed by AOFAS score at various follow-ups of 12, 24, 36, 60 and 72 months. We report the imaging characteristics of osteochondritis dissecans of the tibial articular surface (tibial plafond). PubMed CrossRef Google Scholar Ross KA, Hannon CP, Deyer TW, Smyth NA, Hogan M, Do HT, Kennedy JG. The aproach can best be by anterior arthroscopy. Osteochondral lesions of the tibial plafond are rare compared with osteochondral lesions of the talus, so the treatment guidelines and prognostic indications have not been established. Osteochondritis dissecans of the tibial plafond … If you have access to a journal via a society or association membership, please browse to your society journal, select an article to view, and follow the instructions in this box. indications. If left untreated, osteochondral lesions can further degrade and potentially lead to osteoarthritis2,5,6.How-ever, the treatment guidelines and prognostic indicators that Pearce, CJ, Lutz, MJ, Mitchell, A, Calder, JD. Osteochondral lesions (OCLs) of the tibial plafond (OLTPs) are rare, and few studies provide treatment recommendations. The talar dome is trapezoidal in shape (broader anteriorly) and articulates with the tibial plafond, while the medial and lateral talar facets articulate with the respective malleoli. Osteochondritis dissecans of the talar articular surface of the ankle joint has been well described. There are few cases describing this lesion in the literature, with little information on mechanism of injury, history/physical findings or recommendations for management. (Fig. Ankle injuries may predispose or alter one of these components, therefore compromising the synergistic weight-bearing distribution of the ankle joint. NIH The talus articulates with the tibia (tibial plafond and medial malleolus) and fibula (lateral malleolus) to form the ankle joint. Tibial plafond fractures occur just above the ankle joint and involve that critical cartilage surface of the ankle. 2019 Aug 1;8(8):e875-e881. Members of _ can log in with their society credentials below. For more information view the SAGE Journals Sharing page. It is the most common cause of an intra-articular loose body in adolescents. Material and methods: We assigned 9 zones to the distal tibial plafond … Sign in here to access free tools such as favourites and alerts, or to access personal subscriptions, If you have access to journal content via a university, library or employer, sign in here, Research off-campus without worrying about access issues. These pins are overdrilled with Arthrex 3.4 mm cannulated Trim-It Drill Bit across the medial malleolus and into the tibial plafond. Depending on the type of injury, immobilization may be initiated with the use of a short leg cast or removable walking boot to protect the talus. Bui-Mansfield, LT, Kline, M, Chew, FS, Rogers, LF, Lenchik, L. Cuttica, DJ, Smith, WB, Hyer, CF, Philbin, TM, Berlet, GC. Epub 2018 Feb 23. 4,18 The term pilon fracture was first used in 1911 by Destot, who likened the distal tibia to a pestle. Create a link to share a read only version of this article with your colleagues and friends. Chapter 2 22 Introduction An osteochondral defect (OCD) is the collec-tive term for focal lesions involving the articular cartilage and subchondral bone. Osteochondral lesions of the tibial plafond are rare compared with osteochondral lesions of the talus, so the treatment guidelines and prognostic indications have not been established. The AOFAS score improved from 52.4 preoperatively to 80.6 at the mean final follow-up. Introduction. Objectives: OCD can occur in any diarthrodial joint, … The holes are then … Footnote: (a) An illustration in the mid-sagittal plane is demonstrating the involved anterior joint capsule (circle) with associated osteophytes from the anterior tibial plafond and anterior talar neck. Arthroscopic microfracture provided satisfactory clinical outcomes for osteochondral lesions of the tibial plafond. For example, those with OCD of the knee are immobilized for four to six weeks or even up to … The mean FAAM score was improved from 57.6 (range, 6.0-88.9) for the activities of daily living subscale and 34.5 (range, 3.1-92.6) for the sports subscale to 84.3 (range, 46.4-100.0) and 65.2 (range, 23.3-55.1) for each subscale, respectively, at the final follow-up. With tibial plafondplasty, non-perpendicular access to the talar dome is achieved using standard soft tissue exposure combined with limited anterior resection of a small, stable, triangular wedge of bone … We believe that this technique is a viable treatment option for patients with intact OCD lesions who have not responded to nonoperative management. Outcomes after tibial plafond fractures are variable but typically they are not excellent. Tibial pilon fractures: a comparative clinical study of management techniques and results. Treatment Strategy and Surgical Approach for OCD of the Talus Feat. This product could help you, Accessing resources off campus can be a challenge. Eur J Orthop Surg Traumatol. Please enable it to take advantage of the complete set of features! Foot Ankle Int. The posterior process is supplied by … Osteochondritis dissecans of the talar articular surface of the ankle joint has been well described. Non-Operative Treatment … Wukich, DK, Sambenedetto, TL, Mota, NM, Suder, NC, Rosario, BL. Laszlo Hangody. You can be signed in via any or all of the methods shown below at the same time. Treatment: Nonoperative . CT scans are less susceptible to hardware artefacts and motion artefacts compared to MRI. Conditions and check the box to generate a Sharing link provided satisfactory clinical outcomes for osteochondral lesions distal... Laszlo Hangody... osteochondral lesions of the talus only … » cast treatment of OLTPs treatment proceeds according to surrounding! 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