M.E.Müller: Atlas: Fracture 43-B1

Tibia/Fibula, Distal,
partial articular fracture,
pure split 0,63% of the total
3,28% of the tibia
16,90% of the segment

88 fractures
25,4% group
67%M, 33%F

139 fractures
40,2% group
66%M, 34%F

119 fractures
34,4% group
66%M, 34%F

Sagittal +Q Frontal +Q Metaphyseal multifragmentary +Q

These are simple, partial articular fractures of the tibial pilon, with its fracture line being predominantly in the frontal or in the sagittal plane. Ref. U. Heim. The pilon tibial fracture. WB Saunders. 1995.
Surgeon. AO Documentation Centre. Davos.

When the quality of the bone stock is good, there is no bone loss because of impaction and the articular fracture is linear. In such a case, anatomic reduction and compression can be obtained with 3.5 mm cancellous screws, making unnecessary the use of plates.

In the illustrated B1.2 case, the easy reduction and stabilization of the tibial fracture makes it easier to restore the length of the fibula, which as an exception to the general rule, can then be internally fixed as the second surgical step.

The T plate is not a good implant choice for the pilon fractures. The plate is too thick and its horizontal branch almost impossible to contour to the malleolar surface, making it to bulge through the subcutaneous tissue with the consequent great risk for skin necrosis. In the illustrated B1.1 case, internal fixation with lag screws would have been enough, with or without a small plate with an anti-slip and a buttress function.

preoperative preoperative

+ 1 year + 1 year

preoperative preoperative

+ 0 month + 0 month

+ 1 year + 1 year

preoperative + 1 year + 1 year




						Tibia/Fibula, Distal, partial articular fracture, pure split	0,63% of the total 3,28% of the tibia 16,90% of the segment






These are simple, partial articular fractures of the tibial pilon, with its fracture line being predominantly in the frontal or in the sagittal plane.		Ref. U. Heim. The pilon tibial fracture. WB Saunders. 1995. Surgeon. AO Documentation Centre. Davos.

When the quality of the bone stock is good, there is no bone loss because of impaction and the articular fracture is linear. In such a case, anatomic reduction and compression can be obtained with 3.5 mm cancellous screws, making unnecessary the use of plates. In the illustrated B1.2 case, the easy reduction and stabilization of the tibial fracture makes it easier to restore the length of the fibula, which as an exception to the general rule, can then be internally fixed as the second surgical step.	The T plate is not a good implant choice for the pilon fractures. The plate is too thick and its horizontal branch almost impossible to contour to the malleolar surface, making it to bulge through the subcutaneous tissue with the consequent great risk for skin necrosis. In the illustrated B1.1 case, internal fixation with lag screws would have been enough, with or without a small plate with an anti-slip and a buttress function.