Dr. Ebraheim’s educational animated video describes tibial plafond fracture classifications.
Ruedi -Allgower classification
Type I
•No significant joint incongruity.
•Cleavage fracture with no displacement of the fractured fragments.
Type II
•Significant incongruity.
•Minimal metaphyseal comminution or impaction.
Type III
•Significant articular comminution and metaphyseal impaction (bad injury).
AO/OTA classification
1-A extra-articular
2-B partial-articular
3-C complete articular
I don’t think you can go wrong with classifying any fracture that involves or close to a joint as an extra-articular, partial-articular or complete articular.
A extra-articular
•A1 metaphyseal simple
•A2 metaphyseal wedge
•A3 metaphyseal complex
All of these extra-articular fractures are named A based upon the complexity of the fracture.
B partial articular
•B1 pure split
•B2 split depression:
Supination/abduction fracture of the ankle will have a vertical fracture of the medial malleolus.
The anteromedial portion of the plafond may also be impacted.
This fracture shows up in classic orthopedic examinations.
This impaction or depression can be missed.
What would you do after fixation of this fracture and the impaction fracture is missed?
You probably need to revise the fixation and make sure to elevate the impaction or depression.
Restore the joint congruity before fixing the fracture.
When you fix the fracture, fix it with a plate or with screws.
oThe screws have to be parallel to the joint to compress the fracture.
Plate fixation should be done with an antiglide plate.
•B3 multi-fragmentary depression
C complete articular
•C1 articular simple, metaphysis simple
•C2 articular simple, metaphysis multi-fragmentary
•C3 articular multi-fragmentary, metaphysis multi-fragmentary. Difficult fracture with the worse prognosis.
Classically, there is a typical pilon fracture fragments. Usually, there are three main joint fragments. The three fragments are:
1-Medial malleolus: attached to the deltoid ligament.
2-Anterolateral fragment: Chaput fragment (attached to the anterior inferior tibiofibular ligament).
3-Volkman fragment: posterolateral fragment attached to the posterior inferior tibiofibular ligament.
In this CT scan, you can see the three fragments of the pilon fracture as well as joint impaction.
When the fibula is intact, the lateral collateral ligament of the ankle may rupture (fibula is intact in 20% of the cases)
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