Distal Tibia Fractures


This fracture is unusual, which makes treatment particularly difficult, because experience and judgment are required for optimal results. The mechanism of injury is inherently part of the diagnosis of this category of ankle fracture. Tibial plafond or pilon fractures occur through a mechanism that must have at least a component of axial load; most occur either from a fall from a height or a motor vehicle accident, with each of these mechanisms accounting for approximately 50% of the fractures. The axial load produces the intra-articular injury, the energy release that injures the soft tissues, and the fracture patterns that are typically associated with this fracture category. Fractures caused by rotation and nonarticular fractures of the distal tibia caused predominately by bending produce different fracture patterns with different prognoses and are treated with different techniques. Definitive treatment of most distal tibial fractures includes one of the following techniques: spanning external fixation with screw fixation for the articular surface, ring/wire fixation, or delayed plating often following initial temporary spanning external fixation.

This article reviews the pathophysiology and clinical presentation of distal tibia fractures and reviews the surgical management options. The technique of spanning articulated external fixation is specifically reviewed.

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