M.E.Müller: Atlas: Fracture 43-C1

Tibia/Fibula, Distal, complete
articular fracture, articular simple,
metaphyseal simple 0,60% of the total
3,12% of the tibia
16,07% of the segment

80 fractures
24,3% group
68%M, 32%F

112 fractures
34,0% group
57%M, 43%F

137 fractures
41,7% group
61%M, 39%F

Without depression +Q With depression +Q Extending into the diaphysis +Q

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preoperative preoperative postoperative

+ 7 months + 7 months

+ 1 years + 1 years + 2 years

These are complete articular fractures of the tibial pilon, with a simple fracture line but with depression and associated to a simple metaphyseal fracture. Ref. U. Heim. The pilon tibial fracture. WB Saunders. 1995.
Surgeon. AO Documentation Centre. Davos.

Since this is a complete articular fracture with several fragments, it is preferable to begin the surgical procedure with their reduction and provisional fixation with Kirschner wires, that can be later either removed or used to place cannulated screws. The most difficult fragment to reduce is the postero-lateral one.

Once the epiphysis is stabilized, it is fixed to the diaphysis with a plate that buttresses and/or neutralizes the previously reduced metaphyseal fracture. Among other advantages, the cloverleaf plate is easy to adapt to the malleolar surface and offers the possibility to insert several screws through it. Its only disadvantage is due to its thinness (possible bending deformation) and this can be overcome by placing another plate, a one-third tubular one, on the anterior aspect of the pilon (double plate).

preoperative preoperative

postoperative postoperative

+ 2 years + 2 years

preoperative preoperative

postoperative postoperative

These are complete articular fractures of the tibial pilon with a simple fracture line, with or without articular depression and extending into the diaphysis. They differ from the C1.2 in that the fracture line exceeds the metaphyseal area. Ref. U. Heim. The pilon tibial fracture. WB Saunders. 1995.
Surgeon. RO, RO.

In the illustrated cases, the depression is predominantly anterior and the fracture line ascends through the diaphysis in the frontal plane. It is for that reason that the main implants are the antero-posterior screws. The superior screws, placed first, compress the diaphyseal cortices and limit the problem to the articular fracture, that must be treated according to the standard technique: reduction and addition of bone graft when necessary. The antero-posterior cancellous screws close the epiphyseal cortex as if it was the cover of a box. The medial cloverleaf plate, with very few screws, has a neutralization effect on the metaphyseal fracture and a buttress effect on the epiphyseal fracture.

In the first illustrated case, the main problem is the articular fragment of the postero-lateral corner of the pilon. If the automatic reduction obtained by the reduction of the metaphyseal fracture is not anatomical, a direct lateral retro-malleolar approach will be required. Lack of care in exact reduction of this fragment ussually bears serious consequences (early degenerative arthritis).

preoperative preoperative

postoperative postoperative

preoperative preoperative

+ 1 year + 1 year




						Tibia/Fibula, Distal, complete articular fracture, articular simple, metaphyseal simple	0,60% of the total 3,12% of the tibia 16,07% of the segment






These are complete articular fractures of the tibial pilon, with a simple fracture line but with depression and associated to a simple metaphyseal fracture.		Ref. U. Heim. The pilon tibial fracture. WB Saunders. 1995. Surgeon. AO Documentation Centre. Davos.

Since this is a complete articular fracture with several fragments, it is preferable to begin the surgical procedure with their reduction and provisional fixation with Kirschner wires, that can be later either removed or used to place cannulated screws. The most difficult fragment to reduce is the postero-lateral one.	Once the epiphysis is stabilized, it is fixed to the diaphysis with a plate that buttresses and/or neutralizes the previously reduced metaphyseal fracture. Among other advantages, the cloverleaf plate is easy to adapt to the malleolar surface and offers the possibility to insert several screws through it. Its only disadvantage is due to its thinness (possible bending deformation) and this can be overcome by placing another plate, a one-third tubular one, on the anterior aspect of the pilon (double plate).






These are complete articular fractures of the tibial pilon with a simple fracture line, with or without articular depression and extending into the diaphysis. They differ from the C1.2 in that the fracture line exceeds the metaphyseal area.		Ref. U. Heim. The pilon tibial fracture. WB Saunders. 1995. Surgeon. RO, RO.

In the illustrated cases, the depression is predominantly anterior and the fracture line ascends through the diaphysis in the frontal plane. It is for that reason that the main implants are the antero-posterior screws. The superior screws, placed first, compress the diaphyseal cortices and limit the problem to the articular fracture, that must be treated according to the standard technique: reduction and addition of bone graft when necessary. The antero-posterior cancellous screws close the epiphyseal cortex as if it was the cover of a box. The medial cloverleaf plate, with very few screws, has a neutralization effect on the metaphyseal fracture and a buttress effect on the epiphyseal fracture.	In the first illustrated case, the main problem is the articular fragment of the postero-lateral corner of the pilon. If the automatic reduction obtained by the reduction of the metaphyseal fracture is not anatomical, a direct lateral retro-malleolar approach will be required. Lack of care in exact reduction of this fragment ussually bears serious consequences (early degenerative arthritis).