Tuan Anh Nguyen, Man Duc Minh Phan, Phi Duong Nguyen
Single-stage fixation was technically feasible in this highly selected patient with stable physiology, a closed injury, a clinically viable soft-tissue envelope and a distal articular fracture. This single case does not establish equivalence or superiority to staged management, particularly for severely comminuted or soft-tissue-compromised pilon injuries.
BACKGROUND: Simultaneous ipsilateral fractures of the proximal and distal tibial articular ends are uncommon. Although this pattern has sometimes been described as a 'floating tibia', the term is not standardised. Management is dictated by fracture morphology, soft-tissue status, patient physiology and the ability to obtain stable articular reduction without additional soft-tissue injury.
CASE PRESENTATION: A 45-year-old man sustained a closed Schatzker VI tibial plateau fracture, an ipsilateral partial-articular distal tibial plafond fracture documented as AO/OTA 43-B2 and a comminuted fibular fracture after a motorcycle accident. The patient was haemodynamically stable, had intact distal neurovascular findings and had marked but clinically viable soft tissues without open wounds or fracture blisters (Tscherne Grade II). Preoperative CT was performed and informed planning; however, the original CT data and reconstructed images are no longer retrievable because of limited long-term digital archiving and storage resources in the treating setting in Vietnam. Single-stage fixation was undertaken within 10 h of injury after repeated clinical assessment. The plateau was treated with limited open elevation of the depressed lateral articular surface and submuscular lateral locking-plate fixation; the fibula was plated, and the distal plafond split was reduced percutaneously and fixed with cannulated lag screws. At 6 months, plain radiographs demonstrated union without loss of alignment (MPTA 87°, LDTA 89°). Knee motion was 0°-120°; ankle motion was documented as 10° dorsiflexion and 30° plantarflexion. The Knee Society scores were 85 (knee) and 80 (function), and the AOFAS Ankle-Hindfoot Scale score was 82. No wound infection, loss of reduction, implant failure, nonunion or unplanned reoperation was documented in the available follow-up record. Elective implant removal was performed at 18 months after union at the patient's request.
CONCLUSION: Single-stage fixation was technically feasible in this highly selected patient with stable physiology, a closed injury, a clinically viable soft-tissue envelope and a distal articular fracture. This single case does not establish equivalence or superiority to staged management, particularly for severely comminuted or soft-tissue-compromised pilon injuries.