M.E.Müller: Atlas: Fracture 43-A3

Tibia/Fibula, Distal,
extra-articular fracture, complex 0,30% of the total
1,57% of the tibia
8,11% of the segment

19 fractures
11,4% group
56%M, 44%F

68 fractures
41,0% group
52%M, 48%F

79 fractures
47,6% group
71%M, 29%F

Three intermediate fragments +Q More than three intermediate fragments +Q Extending into the diaphysis +Q

These are complex extra-articular fractures of the tibial pilon with more than three intermediate fragments. Ref. U. Heim. The pilon tibial fracture. WB Saunders. 1995.
Surgeon. RO.

The first surgical step should be the reduction of the fibula and its internal fixation with a one-third tubular plate, thus reconstructing the lateral column of the ankle mortice. The tibia is then exposed through an anteromedial approach and it is reduced anatomically, using the fibula as a model and as a splint.

The internal fixation is performed with a cloverleaf plate placed on the medial aspect of the tibia. This plate must be carefully contoured in all planes in order to obtain its perfect adaptation, including the tips of the cloverleaf,

and avoid its protrusion through the subcutaneous tissue. Since this is a thin implant, it adapts to the bone at the time of screwing, contrary to what happens with the thicker implants. The screw holes of the plate are round and do not allow for dynamic compression. Another plate, of the semitubular type and flattened at its distal end for a better adaptation to the pilon, will give excellent supplemental stability and allow for early non-weight-bearing range of motion of the ankle. Its oval screw holes will allow for some degree of compression.

preoperative postoperative

+ 1 year + 1 year




						Tibia/Fibula, Distal, extra-articular fracture, complex	0,30% of the total 1,57% of the tibia 8,11% of the segment






These are complex extra-articular fractures of the tibial pilon with more than three intermediate fragments.		Ref. U. Heim. The pilon tibial fracture. WB Saunders. 1995. Surgeon. RO.

The first surgical step should be the reduction of the fibula and its internal fixation with a one-third tubular plate, thus reconstructing the lateral column of the ankle mortice. The tibia is then exposed through an anteromedial approach and it is reduced anatomically, using the fibula as a model and as a splint. The internal fixation is performed with a cloverleaf plate placed on the medial aspect of the tibia. This plate must be carefully contoured in all planes in order to obtain its perfect adaptation, including the tips of the cloverleaf,	and avoid its protrusion through the subcutaneous tissue. Since this is a thin implant, it adapts to the bone at the time of screwing, contrary to what happens with the thicker implants. The screw holes of the plate are round and do not allow for dynamic compression. Another plate, of the semitubular type and flattened at its distal end for a better adaptation to the pilon, will give excellent supplemental stability and allow for early non-weight-bearing range of motion of the ankle. Its oval screw holes will allow for some degree of compression.