M.E.Müller: Atlas: Fracture 42-A1

Tibia/Fibula, Diaphysis,
simple fracture, spiral
2,28% of the total
11,76% of the tibia
21,10% of the segment

522 fractures
42,1% group
61%M, 39%F

453 fractures
36,5% group
59%M, 41%F

265 fractures
21,4% group
60%M, 40%F

Fibula intact +Q Fibula fractured at another level +Q Fibula fractured at the same level +Q

These are simple diaphyseal fractures of the tibia with a spiral fracture line, located at whatever level of the diaphysis. The characteristic that differentiates the subgroups is whether or not there is an associated fracture of the fibula and, if so, its level in relationship to the tibial fracture: In the subgroup .1 the fibula is intact; In the subgroup .2 the fracture of the fibula is at a different level than the fracture of the tibia; In the subgroup .3 the fibula is fractured at the same level than the tibia. Ref. Manual of Internal Fixation:
200 - 207. 232 - 251. 574 - 587.
Surgeon. RO, RO.

These fractures are amenable to conservative treatment, usually healing without delays but with the drawback of some shortening. Nevertheless, the spiral fractures of the tibia can be anatomically reduced, and we believe they should be. Once the broad fracture surface is in contact and compressed with a lag screw, the stability attained is remarkable. A plate screwed to the proximal and distal fragments will protect the interfragmentary compression (neutralization or protection plate).

The use of a plate requires proper contouring and insertion technique, necessary to obtain adequate

indirect reduction, anti-skidding and prestressing effects,concepts extensively described in the AO Manual. The prestressing effect depends on the elasticity of the metal; therefore, the softer titanium plates will have it at a lesser degree.

In the illustrated A1.1 fracture, the lag screw is independent from the plate. In the A1.2 fracture, the lag screw is placed through one of the plate holes. All perfectly reduced and stabilized tibial fractures will heal “per primam”, without a radiologically visible callus.

preoperative postoperative + 3 year

preoperative + 1 month + 2 month + 4 month

preoperative preoperative + 3 month + 3 month

+ 2 years + 2 years

These are the most serious fractures of the group because the fibula is fractured at the same level than the tibia. Ref. Manual of Internal Fixation:
200 - 207. 232 - 251. 574 - 587.
Surgeon. RO.

Because of the great instability caused by the fracture of both bones being at the same level, the indication for surgical treatment is stronger for the fractures of the .3 subgroup than for the previous subgroups.

In the illustrated case, the interfragmentary compression of the tibia is obtained by one independent screw and another one through one of the holes of the protection

plate. The complex fracture of the fibula, serious because of its location at the level of the syndesmosis, has been reduced and fixed with a one-third tubular plate which distal end has been contoured as a hook. A screw between the tibia and the fibula, above the syndesmosis, provisionally positions the distal tibio-fibular joint and will have to be removed at 6 weeks in order to maintain the elasticity of the ankle mortice.

preoperative preoperative + 4 month + 4 month

preoperative preoperative

+ 1 month + 3 month + 4 month + 4 month

preoperative preoperative + 3 month + 3 month

w




						Tibia/Fibula, Diaphysis, simple fracture, spiral	2,28% of the total 11,76% of the tibia 21,10% of the segment






These are simple diaphyseal fractures of the tibia with a spiral fracture line, located at whatever level of the diaphysis. The characteristic that differentiates the subgroups is whether or not there is an associated fracture of the fibula and, if so, its level in relationship to the tibial fracture: In the subgroup .1 the fibula is intact; In the subgroup .2 the fracture of the fibula is at a different level than the fracture of the tibia; In the subgroup .3 the fibula is fractured at the same level than the tibia.		Ref. Manual of Internal Fixation: 200 - 207. 232 - 251. 574 - 587. Surgeon. RO, RO.

These fractures are amenable to conservative treatment, usually healing without delays but with the drawback of some shortening. Nevertheless, the spiral fractures of the tibia can be anatomically reduced, and we believe they should be. Once the broad fracture surface is in contact and compressed with a lag screw, the stability attained is remarkable. A plate screwed to the proximal and distal fragments will protect the interfragmentary compression (neutralization or protection plate). The use of a plate requires proper contouring and insertion technique, necessary to obtain adequate	indirect reduction, anti-skidding and prestressing effects,concepts extensively described in the AO Manual. The prestressing effect depends on the elasticity of the metal; therefore, the softer titanium plates will have it at a lesser degree. In the illustrated A1.1 fracture, the lag screw is independent from the plate. In the A1.2 fracture, the lag screw is placed through one of the plate holes. All perfectly reduced and stabilized tibial fractures will heal “per primam”, without a radiologically visible callus.






These are the most serious fractures of the group because the fibula is fractured at the same level than the tibia.		Ref. Manual of Internal Fixation: 200 - 207. 232 - 251. 574 - 587. Surgeon. RO.

Because of the great instability caused by the fracture of both bones being at the same level, the indication for surgical treatment is stronger for the fractures of the .3 subgroup than for the previous subgroups. In the illustrated case, the interfragmentary compression of the tibia is obtained by one independent screw and another one through one of the holes of the protection	plate. The complex fracture of the fibula, serious because of its location at the level of the syndesmosis, has been reduced and fixed with a one-third tubular plate which distal end has been contoured as a hook. A screw between the tibia and the fibula, above the syndesmosis, provisionally positions the distal tibio-fibular joint and will have to be removed at 6 weeks in order to maintain the elasticity of the ankle mortice.