M.E.Müller: Atlas: Fracture 43-A2

Tibia/Fibula, Distal,
extra-articular fracture, wedge 0,44% of the total
2,27% of the tibia
11,68% of the segment

54 fractures
22,6% group
67%M, 33%F

88 fractures
36,8% group
68%M, 32%F

97 fractures
40,6% group
67%M, 33%F

Postero-lateral impaction +Q Antero-medial wedge +Q Extending into the diaphysis +Q

These are extra-articular fractures of the distal tibia, multifragmentary, with an antero-medial metaphyseal wedge. Ref. U. Heim. The pilon tibial fracture. WB Saunders. 1995.
Surgeon. AO Documentation Centre. Davos.

When such a fracture is associated with a fracture of the fibula, surgery must begin with the reduction of the fibula and its stabilization with a one-third tubular plate. This maneuver will align the tibia and give the length standard. The tibial pilon fracture must be anatomically reduced and fixed with a contoured straight plate or with a cloverleaf plate.

We want to remark two details of the illustrated case. Two 4.5 mm screws have been used in the diaphyseal

area even though the plate screw holes are prepared for 3.5 mm screws. Such “license” is permisible only at the diaphyseal level, being sometimes useful. The second detail that we want to point out is the false radiographic image on the antero-posterior view, where one screw appears to be placed intra-articular. Like in the previous A1.2 case, the lateral view shows the screw in the anterior border of the tibia without penetration into the joint. Again, we want to emphasize this frequent radiographical assesment detail.

preoperative preoperative

postoperative postoperative

+ 1 year + 1 year




						Tibia/Fibula, Distal, extra-articular fracture, wedge	0,44% of the total 2,27% of the tibia 11,68% of the segment






These are extra-articular fractures of the distal tibia, multifragmentary, with an antero-medial metaphyseal wedge.		Ref. U. Heim. The pilon tibial fracture. WB Saunders. 1995. Surgeon. AO Documentation Centre. Davos.

When such a fracture is associated with a fracture of the fibula, surgery must begin with the reduction of the fibula and its stabilization with a one-third tubular plate. This maneuver will align the tibia and give the length standard. The tibial pilon fracture must be anatomically reduced and fixed with a contoured straight plate or with a cloverleaf plate. We want to remark two details of the illustrated case. Two 4.5 mm screws have been used in the diaphyseal	area even though the plate screw holes are prepared for 3.5 mm screws. Such “license” is permisible only at the diaphyseal level, being sometimes useful. The second detail that we want to point out is the false radiographic image on the antero-posterior view, where one screw appears to be placed intra-articular. Like in the previous A1.2 case, the lateral view shows the screw in the anterior border of the tibia without penetration into the joint. Again, we want to emphasize this frequent radiographical assesment detail.