Ballistic Tibial Plafond Fractures Compared with Blunt Open Tibial Pilon Fractures: A Control-Matched Study

INTRODUCTION: It is well documented that blunt, open tibial plafond fractures are severe injuries with high complication rates; however, there is a paucity of literature on ballistic intraarticular tibial plafond fractures. The purpose of this study is to determine the differences in outcomes between ballistic tibial plafond fractures and open pilon fractures. METHODS: We report on a consecutive series of patients over a 10-year period that presented to a single level I trauma center with an OTA 43C ballistic tibial plafond fracture. A control group consisting of patients with open pilon fractures matched for OTA classification, Gustilo-Anderson classification, and fixation method was used for comparison. Pearson’s chi-square and Fischer’s exact tests were utilized to determine differences between groups. RESULTS: A total of 27 ballistic tibial plafond fracture patients treated surgically were identified. The control matched group consisted of 21 patients. Fixation was achieved using the following methods: primary open reduction internal fixation (ORIF) (n = 8), primary external fixation (n = 21), staged external fixation and delayed ORIF (n = 18), and staged external fixation and delayed intramedullary nail (n = 1). There was no difference in rates of deep infection (19% vs 38%, p = 0.13) and superficial infection (41% vs 33%, p = 0.60) between the ballistic and control group. CONCLUSION: Our study demonstrates that ballistic intraarticular tibial plafond fractures are severe injuries that have similar outcomes to blunt, open pilon fractures that occur with high-energy axial loading. Although ballistic tibial plafond fractures are rare, our data reveal similarly high complication rates to blunt, open pilon fractures.