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DEFINITION
Distal tibia fractures are primarily located within a square based on the width of the distal tibial metaphysis.
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
PRIMARY MANAGEMENT
Bulky padding POP splint/ BB
splint Temporary Exfix Strict elevation Pain relief
Debridement & Lavage
Temporary Ex fix Antibiotics Relook after 48 hrs Plastic surgery opinion Elevation
Closed fractures
Open fractures
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
Anterolateral approach
•For fractures involving posterolateral 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
CONCLUSION
Very challenging fractures Unpredictable results Soft tissue considerations are of
paramount importance Fix fibula first Articular congruity