Basic idea about distal tibia fractures

1. DISTAL TIBIA
FRACTURES
DR. SABYASACHI BARDHAN

2. DEFINITION
 Distal tibia fractures
are primarily located
within a square
based on the width
of the distal tibial
metaphysis.

3. ANATOMY
Internal rotation of
distal tibia

4. SOFT TISSUE
Paucity
of soft
tissue
coverag
eon the
anterior
aspect

5. EPIDEMIOLOGY
 Avg. age 35-40
 Rare in children
 Males 3 x more common
 3-9% of all tibia fractures
 Associated injuries 25-50%

6. MECHANISM
 Axially directed force
Intra articular fractures
More soft tissue injury
High energy/ open
injuries
 Rotational force
Spiral fractures
Variable amount of soft
tissue
injuries/ open fractures

7. RUDI ALLGOWER
CLASSIFICATION
Type 1
Type 2
Type3

8. AO CLASSIFICATION: 43
A:
Extraarticula
r
B:
Partial
articular
C:
Complete
articular

9. CLINICAL PRESENTATION
Pain
Swelling
Deformity
……………
Blisters
Open
wound
Associated
injuries

10. IMAGING
 X Ray  CT Scan

11. PRIMARY MANAGEMENT
 Bulky padding
 POP splint/ BB
splint
 Temporary Exfix
 Strict elevation
 Pain relief
 Debridement &
Lavage
 Temporary Ex fix
 Antibiotics
 Relook after 48 hrs
 Plastic surgery
opinion
 Elevation
Closed fractures Open fractures

12. NON OPERATIVE
 Plaster of paris cast/ Synthetic cast
Undisplaced/Minimally displaced
Rudi Allgower type 1/type 2
AO C3
Poor GC
 Loss of reduction
Stiffness

13. PRE-OP CONSIDERATIONS
 Delay for reduction in swelling, wrinkle signs
 5-10 days (usually within 3 weeks)
 Elevation and splint
 Calcaneal traction/ Ex fix
 Management of blisters

14. PRINCIPLES
Anatomical reduction
Stable internal fixation
Minimal soft tissue damage
Early pain-free mobilization

15. SURGICAL OPTIONS
 Open reduction and internal fixation
 Percutaneous fixation
 MIPO
 IM Nail
 External fixator

16. ORIF
 Should be done with restraint!!
 Done after Soft tissue normalizes
 Low profile plates
 Locking plates
 Fibula first
 One stage or 2 stage
 Anteromedial or Posterolateral approach

17. Anteromedial Approach
 Fracture involves
the medially aspect
 Plate on
subcutaneous
surface

18. Anterolateral approach
•For
fractures
involving
posterola
teral
corners
•Plate
under
extensor
muscles

19. PERCUTANEOUS SCREW
FIXATION
 For mildly displaced
fractures A, B1,B2,
C1
 Indirect reduction by
external fixator or
distractor is very
useful

20. MIPO
 Type A, B and sometimes Type C1, C2
 Indirect reduction by ligamentotaxis
 Plate on medial surface

22. IM Nail
IM Nail
suppleme
nted with
screws

23. EXTERNAL FIXATOR
 Type A3, B3,C3
 Poor soft tissue condition

24. COMPLICATIONS
Malunion
Ankle
stiffness
Arthritis
Skin
necrosis
Wound
dehisenc
e

25. CONCLUSION
 Very challenging fractures
 Unpredictable results
 Soft tissue considerations are of paramount
importance
 Fix fibula first
 Articular congruity

26. THANK
YOU