For this procedure an anteromedial approach is used. 1.2 Operative fracture management Operative treatment of displaced unstable tibia shaft fractures is the treatment of choice if it can be performed in facilities with the necessary equipment and skills. This wire will become part of the fragment’s definitive fixation when it is cut and buried inside the completely reduced fracture (“lost” K-wire). Distal Tibial Fractures. Careful use of fluoroscopy and physical exam are essential for assessing alignment. Distraction is used for the open reduction and plate fixation of the fibula as first step (if not yet already fixed) and for the reduction of the articular surface of the tibia as a second step. AO/OTA Fracture and Dislocation Classification Compendium—2018. This fragment is fixed preliminarily with a K-wire. Angular stable fixation may obscure signs of non-union for many months. Preoperative planning is an essential part of treatment of all pilon fractures. The best time for implant removal is after complete remodeling, usually at least 12 months after surgery. Therefore, full weight bearing was started at that time. Fracture classified according to AO classification of fracture distal tibia. However, this may be performed at the time of flap coverage in certain circumstances. © AO Foundation - AO Principles of Fracture Management—Third Edition, Intramedullary nailing of metaphyseal fractures of the tibia, Minimally Invasive Osteosynthesis—Distal tibia and pilon, Pilon Fractures - Advances in the Surgical Management, Tibia—Intraarticular fracture—Large external fixator: ankle-bridging delta frame, Distal Tibia 43-A1 - Percutaneous Plating - LCP Distal Tibia Plate, Tibia, distal - Pilon tibial fractures - Buttress of the distal tibia with plates and/or screws, and cancellous autograft, Distal tibia and fibula - Multifragmentary fracture - Percutaneous plate fixation of the lower leg (MIPO technique), Tibia, distal- pilon tibial fracture (type 43-C3.3) - Fracture fixation using LCP-Distal Tibia Plate, Minimally invasive plate osteosynthesis (MIPO) of the distal tibia fracture. tibia fixation, with and without fibula fixation, for both a corticotomy and a 1cm fracture gap. Before wound closure, radiographic confirmation of joint congruity, length, and axial alignment is mandatory (see also the content on assessment of reduction). The syndesmotic ligaments are usually intact, so gross realignment of the fibula occurs with reduction and fixation of the tibia (especially of the anterolateral and posterolateral fragments) as shown in figure (b). Now the central part of the fracture with several articular fragments is visible. 1a). IMN and plate were used in both groups, and patients without fibular fixation was control … For this, they have to follow proper tibia fibula fracture rehabilitation protocol. AO Principles of Fracture Management is an essential resource for orthopedic trauma surgeons and residents in these specialties. Traditional treatment options for distal metaphyseal tibia fractures are antegrade insertion of elastic intramedullary nails, open reduction plate fixation, and external fixator fixation. (Tscherne classification, closed fracture grade 0, rarely grade 1). Alternatively, the K-wire may be replaced by a resorbable pin. When the soft tissues are healed (4-6 weeks), the large lateral bone defect will be filled with an extensive cancellous bone graft from the posterior iliac crest. Supervised rehabilitation with intermittent clinical and radiographic follow-up is advisable every 6-12 weeks until recovery reaches a plateau, typically 6-12 months after injury. The case example is showing injury, preoperative plan, and end result with double plating fixation technique. Each tibia and fibula received a corticotomy 4 centimeters above the joint line. CONCLUSION: MIPO technique can be beneficial for the treatment of distal tibia AO/OTA A and B type fractures with reduced hospital stay, cost-effectiveness, and infection rate. In this article, we are going to learn about each step of the physiotherapy after fracture tibia fibula. 1- Humerus 2- Radius/Ulna 3- Femur 4- Tibia/Fibula 1 Humerus 2 Radius/Ulna 1 = Proximal After six weeks, the soft tissues have healed uneventfully, allowing the planned bone grafting of this large defect. If the screws provide adequate stability, the anterior K-wires can be removed. The 2018 revision of the AO/OTA Fracture and Dislocation Classification Compendium for adults and children addresses the many suggestions to improve the application of the system, as well as add recently published and validated classifications. Forty patients were treated with using the LSN concept and 17 patients with the BP concept. The anterior cortical defect is closed just above the subchondral bone. By Christopher Haydel, MD, Assistant Professor of Orthopaedic Surgery, Temple University From the 9th Annual Philadelphia Orthopaedic Trauma … The illustrated case is a type 3A open fracture. The entire bone graft has healed in nicely. This preliminary reduction is stabilized with a small K-wire inserted from anteriorly. Especially simple fractures, i.e. The anatomical reduction of the joint block and correct alignment of the distal fibula and tibia is radiographically checked at the end of the operation. Through a posterolateral straight approach, the fibula is stabilized with a plate. This will allow the anterior metaphyseal fragment to be reduced anatomically into the remaining defect. It is essential to obtain correct length, axis and rotation before the first screw is applied in the diaphysis. Radiographs after external skeletal fixator and screws removal. MIPO technique can be beneficial for the treatment of distal tibia AO/OTA A and B type fractures with reduced hospital stay, cost-effectiveness, and infection rate. It describes the complete surgical management process from diagnosis to aftercare for fractures in a given anatomical region, and also assembles relevant published AO … The distal tibia fracture was graded according to the AO Foundation/Orthopaedic Trauma Association (OTA/AO) classification scheme … use of multiple small incisions that can include. Therefore, it was used for the illustrated case. Depending on the consolidation, weight bearing can be increased after 6-8 weeks with full weight bearing usually after 3 months. Distal tibia fracture is a fracture that involves the metaphyseal area of the distal tibia and may extend to its weight-bearing articular surface1. The patients were followed up every four weeks till radiological union was seen. A subsequent CT scan clarifies the comminution of the articular block. A distractor (or external fixator) is a very helpful tool for reduction. The distal tibia fracture was defined as a fracture with its major fracture line located 12 cm above the medial to lateral width of the articular surface of the ankle. The Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) classification incorporates all fractures of the distal tibia, including extra-articular injuries of the distal tibial metaphysis .3 This classification system is much more detailed, describes comminution at multiple levels, and differentiates …