M.E.Müller: Atlas: Fracture 43-C2

Tibia/Fibula, Distal, complete
articular fracture, articular simple,
metaphyseal multifragmentary 0,37% of the total
1,90% of the tibia
9,77% of the segment

37 fractures
18,5% group
65%M, 35%F

65 fractures
32,5% group
64%M, 36%F

98 fractures
49,0% group
64%M, 36%F

With asymmetric impaction +Q Without asymmetric impaction +Q Extending into the diaphysis +Q

These are complete articular fractures of the tibial pilon, articular simple and metaphyseal multifragmentary, with asymmetric impaction. Ref. U. Heim. The pilon tibial fracture. WB Saunders. 1995.
Surgeon. AO Documentation Centre. Davos.

It is essential to first reduce the fibula, in order to restore its length, and fix it with a one-third tubular plate. With this maneuver, when the syndesmosis is intact, the tibial fragment is automatically reduced anatomically by the fulcrum of its medial cortex. If there is no contact in the medial cortex, at least the pilon gets aligned.

The internal fixation of the tibia is performed according to the general criteria previously stated, not forg e t t i n g the addition of bone graft. In the illustrated case, a cloverleaf plate bridges the multifragmentary fracture of the metaphyseal area and the lag screws, placed through the plate, perform interfragmentrary compression of the epiphyseal fragments.

preoperative preoperative

postoperative postoperative

+ 6 years + 6 years

These are complete articular fractures of the tibial pilon, articular simple and metaphyseal multifragmentary, without asymmetric impaction (C2.2) or with extension into the diaphysis. Ref. U. Heim. The pilon tibial fracture. WB Saunders. 1995.
Surgeon. AO Documentation Centre. Davos. JG.

As it is in the previous subgroup, the fibula is the key to the reduction. In the C2.2 subgroup, the fracture of the tibia is totally unstable and with a greater bone loss than the C2.1; for that reason, a generous amount of cancellous bone graft will have to be added to the buttressing internal fixation. The articular fracture is reduced and fixed with lag screws, oriented according to the predominant fracture plane. The buttress plate may be of the cloverleaf type, associated or not to an anterior plate, either semitubular or one-third tubular

When the fracture line is ascending (C2.3), it is essential to first reduce the diaphysis in order to restore its length and alignment. This will be done following the general principles described for the diaphyseal fractures, using lag screws preferably placed through the plate that can be extended distally in order to obtain an epiphyseal buttress effect. The articular fracture, once anatomically reduced, is fixed with lag screws. In the illustrated case two cancellous screws are used, placed antero-posteriorly through the plate. Notice that the spoon plate has not been used in any of the cases because it is too thick for this subcutaneous location.

preoperative preoperative

+ 5 years + 5 years

preoperative preoperative

+ 2 months + 2 months




						Tibia/Fibula, Distal, complete articular fracture, articular simple, metaphyseal multifragmentary	0,37% of the total 1,90% of the tibia 9,77% of the segment






These are complete articular fractures of the tibial pilon, articular simple and metaphyseal multifragmentary, with asymmetric impaction.		Ref. U. Heim. The pilon tibial fracture. WB Saunders. 1995. Surgeon. AO Documentation Centre. Davos.

It is essential to first reduce the fibula, in order to restore its length, and fix it with a one-third tubular plate. With this maneuver, when the syndesmosis is intact, the tibial fragment is automatically reduced anatomically by the fulcrum of its medial cortex. If there is no contact in the medial cortex, at least the pilon gets aligned.	The internal fixation of the tibia is performed according to the general criteria previously stated, not forg e t t i n g the addition of bone graft. In the illustrated case, a cloverleaf plate bridges the multifragmentary fracture of the metaphyseal area and the lag screws, placed through the plate, perform interfragmentrary compression of the epiphyseal fragments.






These are complete articular fractures of the tibial pilon, articular simple and metaphyseal multifragmentary, without asymmetric impaction (C2.2) or with extension into the diaphysis.		Ref. U. Heim. The pilon tibial fracture. WB Saunders. 1995. Surgeon. AO Documentation Centre. Davos. JG.

As it is in the previous subgroup, the fibula is the key to the reduction. In the C2.2 subgroup, the fracture of the tibia is totally unstable and with a greater bone loss than the C2.1; for that reason, a generous amount of cancellous bone graft will have to be added to the buttressing internal fixation. The articular fracture is reduced and fixed with lag screws, oriented according to the predominant fracture plane. The buttress plate may be of the cloverleaf type, associated or not to an anterior plate, either semitubular or one-third tubular	When the fracture line is ascending (C2.3), it is essential to first reduce the diaphysis in order to restore its length and alignment. This will be done following the general principles described for the diaphyseal fractures, using lag screws preferably placed through the plate that can be extended distally in order to obtain an epiphyseal buttress effect. The articular fracture, once anatomically reduced, is fixed with lag screws. In the illustrated case two cancellous screws are used, placed antero-posteriorly through the plate. Notice that the spoon plate has not been used in any of the cases because it is too thick for this subcutaneous location.