M.E.Müller: Atlas: Fracture 42-B1

Tibia/Fibula, Diaphysis,
wedge fracture, bending wedge
1,68% of the total
8,68% of the tibia
15,58% of the segment

158 fractures
17,2% group
79%M, 21%F

369 fractures
40,3% group
70%M, 30%F

389 fractures
42,5% group
75%M, 25%F

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

These are multifragmentary diaphyseal fractures of the tibia with a bending wedge third fragment (a shorter fragment than in the B1 group). Once the fracture is reduced, contact is maintained between the proximal and distal fragments. In the .1 subgroup the fibula is intact. In the .2 subgroup the fibula is fractured at another level and in the .3 subgroup the fibular and tibial fractures are at the same level. Ref. Manual of Internal Fixation:
332 - 364. 106 - 117 (2ª ed.).
Surgeon. RO.

When the tibial fracture is in the middle third and the wedge is small, treatment should be by reamed intramedullary nailing like in the oblique fractures. The third fragment is automatically reduced, more or less accurately, but preserving its blood supply thus helping

the callus formation. The contact between the two large fragments guarantees the stability of the assembly by the direct transfer of the dynamic compression forces guided by the intramedullary tutor.

preoperative preoperative postoperative postoperative

+ 7 month + 7 month + 8 month + 8 month

preoperative preoperative

+ 4 months +4 months + 1 year +1 year

The .3 subgroup fractures, sharing the same general characteristics of the B2 group described in the previous page, are characterized by the coincident level of fracture of the tibia and fibula. In the illustrated cases some minimal fragmentation of the wedges can be observed; This does not change the classification because it does not worsen the global stability. The wedges can be of an anterior, posteromedial or posterolateral base, and this does not change their classification either. Ref. Manual of Internal Fixation:
200 - 207. 232 - 251. 574 - 587.
Surgeon. RO, RO.

Depending on their segmental level, these fractures can be treated with a nail (as described for the B2.2 subgroup) or with a plate (even if they are located at the middle third of the diaphysis). The anatomic reduction and interfragmentary compression with a lag screw, either independent or through the neutralization plate, give the excellent stability demonstrated by the direct callus healing, per primam. In order to preserve the blood supply of the wedge, the plate should preferably be placed in the medial aspect of the diaphysis when the base of the wedge is posterolateral, while in the cases

with a wedge of a posteromedial base the plate should be placed in the lateral aspect.

The option of internal fixation with a plate is conditioned to an accurate technique and strict aseptic conditions. The surgeon will have to perform meticulous approaches, handle the fragments delicately in order to preserve their blood supply, and perform biomechanically prefect internal fixations that achieve long-lasting sufficient stability with the minimum volume of implants.

preoperative postoperative + 4 month + 10 month

preoperative postoperative + 5 month + 1 year

preoperative preoperative + 5 month + 1 year




						Tibia/Fibula, Diaphysis, wedge fracture, bending wedge	1,68% of the total 8,68% of the tibia 15,58% of the segment






These are multifragmentary diaphyseal fractures of the tibia with a bending wedge third fragment (a shorter fragment than in the B1 group). Once the fracture is reduced, contact is maintained between the proximal and distal fragments. In the .1 subgroup the fibula is intact. In the .2 subgroup the fibula is fractured at another level and in the .3 subgroup the fibular and tibial fractures are at the same level.		Ref. Manual of Internal Fixation: 332 - 364. 106 - 117 (2ª ed.). Surgeon. RO.

When the tibial fracture is in the middle third and the wedge is small, treatment should be by reamed intramedullary nailing like in the oblique fractures. The third fragment is automatically reduced, more or less accurately, but preserving its blood supply thus helping	the callus formation. The contact between the two large fragments guarantees the stability of the assembly by the direct transfer of the dynamic compression forces guided by the intramedullary tutor.






The .3 subgroup fractures, sharing the same general characteristics of the B2 group described in the previous page, are characterized by the coincident level of fracture of the tibia and fibula. In the illustrated cases some minimal fragmentation of the wedges can be observed; This does not change the classification because it does not worsen the global stability. The wedges can be of an anterior, posteromedial or posterolateral base, and this does not change their classification either.		Ref. Manual of Internal Fixation: 200 - 207. 232 - 251. 574 - 587. Surgeon. RO, RO.

Depending on their segmental level, these fractures can be treated with a nail (as described for the B2.2 subgroup) or with a plate (even if they are located at the middle third of the diaphysis). The anatomic reduction and interfragmentary compression with a lag screw, either independent or through the neutralization plate, give the excellent stability demonstrated by the direct callus healing, per primam. In order to preserve the blood supply of the wedge, the plate should preferably be placed in the medial aspect of the diaphysis when the base of the wedge is posterolateral, while in the cases	with a wedge of a posteromedial base the plate should be placed in the lateral aspect. The option of internal fixation with a plate is conditioned to an accurate technique and strict aseptic conditions. The surgeon will have to perform meticulous approaches, handle the fragments delicately in order to preserve their blood supply, and perform biomechanically prefect internal fixations that achieve long-lasting sufficient stability with the minimum volume of implants.