DISTAL TIBIA

FRACTURES

DR. SABYASACHI BARDHAN

DEFINITION

 Distal tibia fractures

are primarily located
within a square
based on the width
of the distal tibial
metaphysis.
ANATOMY
Internal rotation of
distal tibia
SOFT TISSUE

Paucity
of soft
tissue
coverag
eon the
anterior
aspect
EPIDEMIOLOGY

 Avg. age 35-40

 Rare in children
 Males 3 x more common
 3-9% of all tibia fractures
 Associated injuries 25-50%
MECHANISM

 Axially directed force

Intra articular fractures
More soft tissue injury
High energy/ open
injuries

 Rotational force
Spiral fractures
Variable amount of soft
tissue
injuries/ open fractures
RUDI ALLGOWER
CLASSIFICATION
Type 1

Type 2

Type3
AO CLASSIFICATION: 43

A:

Extraarticula
r

B:

Partial
articular

C:

Complete
articular
 CLINICAL PRESENTATION

Pain
Swelling
Deformity
……………
Blisters
Open
wound
Associated
injuries
IMAGING

 X Ray  CT Scan
PRIMARY MANAGEMENT

Closed fractures Open fractures

 Bulky padding  Debridement &

Lavage
 POP splint/ BB
splint  Temporary Ex fix
 Temporary Exfix  Antibiotics
 Relook after 48 hrs
 Strict elevation
 Plastic surgery
 Pain relief
opinion
 Elevation
NON OPERATIVE

 Plaster of paris cast/ Synthetic cast

Undisplaced/Minimally displaced
Rudi Allgower type 1/type 2
AO C3
Poor GC

 Loss of reduction
Stiffness
PRE-OP CONSIDERATIONS

 Delay for reduction in swelling, wrinkle signs

 5-10 days (usually within 3 weeks)
 Elevation and splint
 Calcaneal traction/ Ex fix
 Management of blisters
PRINCIPLES

Anatomical reduction

Stable internal fixation

Minimal soft tissue damage

Early pain-free mobilization

SURGICAL OPTIONS
 Open reduction and internal fixation

 Percutaneous fixation

 MIPO

 IM Nail

 External fixator
ORIF

 Should be done with restraint!!

 Done after Soft tissue normalizes
 Low profile plates
 Locking plates
 Fibula first
 One stage or 2 stage
 Anteromedial or Posterolateral approach
Anteromedial Approach

 Fracture involves
the medially aspect
 Plate on
subcutaneous
surface
Anterolateral approach

•For
fractures
involving
posterola
teral
corners

Plate
•
under
extensor
muscles
PERCUTANEOUS SCREW
FIXATION
 For mildly displaced
fractures A, B1,B2,
C1

 Indirect reduction by
external fixator or
distractor is very
useful
MIPO

 Type A, B and sometimes Type C1, C2

 Indirect reduction by ligamentotaxis
 Plate on medial surface
IM Nail

IM Nail
suppleme
nted with
screws
EXTERNAL FIXATOR

 Type A3, B3,C3

 Poor soft tissue condition
 COMPLICATIONS

Malunion
Ankle
stiffness
Arthritis
Skin
necrosis
Wound
dehisenc
e
 CONCLUSION

 Very challenging fractures

 Unpredictable results
 Soft tissue considerations are of paramount
importance
 Fix fibula first
 Articular congruity
THANK
YOU