M.E.Müller: Atlas: Fracture 42-B3

Tibia/Fibula, Diaphysis,
wedge fracture, fragmented wedge
1,02% of the total
5,27% of the tibia
9,46% of the segment

77 fractures
13,8% group
77%M, 23%F

218 fractures
39,2% group
74%M, 26%F

261 fractures
47,0% group
71%M, 29%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 wedge third fragment that is, itself, also fractured in two or more fragments. They are caused by high-energy impact. As in all tibial fractures, the subgroups are defined by the absence of a fibular fracture or by its level in relationship to the tibial fracture. Ref. Manual of Internal Fixation:
200 - 207. 232 - 251. 574 - 587.
Surgeon. RO, JG.

Of special complexity are the fractures of the proximal and distal tibia, where the simple intramedullary nails are not effective and the interlocking nails (internal fixators) do not achieve perfect stabilization, although they may be indicated depending on the status of the soft tissues, frequently damaged in these fractures.

Whenever possible, we prefer to use plates without manipulation of the probably devitalized fragments. In the case shown in the upper half of the page, autologous cancellous bone graft was added to compensate for the relative bone loss caused by the fragmentation of the

wedge and the fibula was internally fixed in order to increase the stability of both, the whole assembly and the syndesmosis. In the case illustrated in the lower half of the page, the fragments spontaneously reduced to the plate, inserted as a bridge, and no bone graft was added. Interfragmentary compression screws should be placed whenever possible, trying not to interfere with the precarious blood supply of the fragments.

External fixation must be considered in all open fractures but keeping in mind that its use will determine other future secondary internal fixation methods.

preoperative postoperative + 1 year

preoperative postoperative + 3 month

+ 2 year + 2 year

preoperative + 18 month + 4 years

The characteristics of this subgroup have been described in the previous page. Ref. Manual of Internal Fixation:
26 - 27. 200 - 207. 232 - 251.
374 - 392. 574 - 587.
Surgeon. RO.

Because these are high-energy fractures, they are frequently associated with soft tissue damage, with considerable edema, even when the skin appears to be intact. In order to get around the skin lesions and avoid detachment of the deep layers, the combined use of an external fixator is sometimes useful. It is useful as a

reduction device (distraction), and leaving it in situ, will substitute a contralateral plate (double plate) that would otherwise be indicated because of the location and characteristics of the fracture. The external fixator is removed when the radiological signs of healing are evident.

preoperative preoperative

postoperative postoperative + 1 year + 1 year




						Tibia/Fibula, Diaphysis, wedge fracture, fragmented wedge	1,02% of the total 5,27% of the tibia 9,46% of the segment






These are multifragmentary diaphyseal fractures of the tibia with a wedge third fragment that is, itself, also fractured in two or more fragments. They are caused by high-energy impact. As in all tibial fractures, the subgroups are defined by the absence of a fibular fracture or by its level in relationship to the tibial fracture.		Ref. Manual of Internal Fixation: 200 - 207. 232 - 251. 574 - 587. Surgeon. RO, JG.

Of special complexity are the fractures of the proximal and distal tibia, where the simple intramedullary nails are not effective and the interlocking nails (internal fixators) do not achieve perfect stabilization, although they may be indicated depending on the status of the soft tissues, frequently damaged in these fractures. Whenever possible, we prefer to use plates without manipulation of the probably devitalized fragments. In the case shown in the upper half of the page, autologous cancellous bone graft was added to compensate for the relative bone loss caused by the fragmentation of the	wedge and the fibula was internally fixed in order to increase the stability of both, the whole assembly and the syndesmosis. In the case illustrated in the lower half of the page, the fragments spontaneously reduced to the plate, inserted as a bridge, and no bone graft was added. Interfragmentary compression screws should be placed whenever possible, trying not to interfere with the precarious blood supply of the fragments. External fixation must be considered in all open fractures but keeping in mind that its use will determine other future secondary internal fixation methods.






The characteristics of this subgroup have been described in the previous page.		Ref. Manual of Internal Fixation: 26 - 27. 200 - 207. 232 - 251. 374 - 392. 574 - 587. Surgeon. RO.

Because these are high-energy fractures, they are frequently associated with soft tissue damage, with considerable edema, even when the skin appears to be intact. In order to get around the skin lesions and avoid detachment of the deep layers, the combined use of an external fixator is sometimes useful. It is useful as a	reduction device (distraction), and leaving it in situ, will substitute a contralateral plate (double plate) that would otherwise be indicated because of the location and characteristics of the fracture. The external fixator is removed when the radiological signs of healing are evident.