Intra-articular fractures of the distal tibia

Abstract

Results of the treatment of intra-articular fractures of the distal tibia have improved significantly during the last two decades.Recognition of the role of soft tissues has led to the development of a staged treatment strategy. At the first stage, joint-bridging external fixation and fibular fixation are performed. This leads to partial reduction of the distal tibial fracture and allows time for the healing of soft tissues and detailed surgical planning.Definitive open reduction and internal fixation of the tibial fracture is performed at a second stage, when the condition of the soft tissues is safe. The preferred surgical approach(es) is chosen based on the fracture morphology as determined from standard radiographic views and computed tomography.Meticulous atraumatic soft-tissue handling and the use of modern fixation techniques for the metaphyseal component such as minimally invasive plate osteosynthesis further facilitate healing.Cite this article: EFORT Open Rev 2017;2:352-361. DOI: 10.1302/2058-5241.2.150047

Malunions and nonunions following tibial malleolar and tibial plafond fractures: current concepts

“…Furthermore, with improvements in surgical techniques and implants, complication rates following ankle and tibial plafond fractures have declined, and outcomes have improved. Correct reduction of the fibula with restoration of length, rotation and axial alignment not only provides a reference for reconstruction of the distal tibia, but it may also facilitate partial reduction of the anterolateral and/or posterolateral fragments as a result of the usually intact syndesmotic ligaments (ligamentotaxis) 24 . Correct reduction of the fibula may help in preventing valgus malalignment of the distal tibia 24 .…”

“…Correct reduction of the fibula with restoration of length, rotation and axial alignment not only provides a reference for reconstruction of the distal tibia, but it may also facilitate partial reduction of the anterolateral and/or posterolateral fragments as a result of the usually intact syndesmotic ligaments (ligamentotaxis) 24 . Correct reduction of the fibula may help in preventing valgus malalignment of the distal tibia 24 . On the other hand, the need for accurate fibula fixation is controversial in cases where restoration of the length of a highly comminute tibia fracture may be impossible to achieve or when external fixation is used for definitive treatment of the fracture 24,25 .…”

“…Correct reduction of the fibula may help in preventing valgus malalignment of the distal tibia 24 . On the other hand, the need for accurate fibula fixation is controversial in cases where restoration of the length of a highly comminute tibia fracture may be impossible to achieve or when external fixation is used for definitive treatment of the fracture 24,25 . The posterolateral fragment is a "key fragment" for the reconstruction of the distal tibia articular surface.…”

“…The posterolateral fragment is a "key fragment" for the reconstruction of the distal tibia articular surface. It may be reduced spontaneously by fixation of the fibula relying on ligamentotaxis, but in approximately 20% of cases, direct reduction is needed which may be achieved by different methods 24 . Reduction through a separate posterolateral or posteromedial approach may be the most accurate, but requires separate procedures and special patient positioning 24,26 .…”

Timing of Surgery for a Tibial Pilon Fractures – Search for a Wise Moment

“…Initial disappointment of both operative and non-operative treatment of pilon fractures in the mid-20 th century was followed by the establishment of AO principles that had traced the way of the modern treatment of pilon fractures [6], [7], [8], [9], [10], [11]. Namely, the AO principles were focused on open reduction and anatomical fixation with absolute stability of the articular fractures.…”