Distal Tibial Fractures
Distal Tibial Fractures
Definition
Metaphyseal
Extra-articular
Intra-articular Extension
Metaphyseal
Extra-articular
< 60 with good bone stock and preserved joint space
Union rates increased with anatomical reduction
Options
- closed reduction
- open reduction / if closed reduction fails
Accept
- no varus
- < 15o valgus
- < 10o AP plane
Non-union
- arrest of progression to union at fracture site
- > 6-9 /12
- no visible progressive signs of healing for at least three consecutive months
- individualise for each fracture
- when the surgeon believes the fracture has little or no chance to heal
Delayed union
- failure of fracture to unite within expected time
- still may spontaneously unite
Direct blow
- most common
Indirect
- forced knee flexion with foot fixed / maximally contracted quadriceps
1. Vertical
2. Transverse
Usually young patients
- 15 - 40
15% compound
High velocity injury
- MBA
- MVA
- pedestrian v car
- fall from height
EMST principles
- need for transfusion not uncommon
Resuscitation
EMST
Neurovascular assessment
Investigations - exclude Pipkin, NOF
Emergent reduction / skeletal stabilisation
Assess stability
Re-evaluate sciatic nerve
Indications
- displaced acetabular fracture
Most common long bone fracture
Young patients / sports
Elderly / simple falls
MVA - often compound
Grade 0
- nil ST injury
Grade 1
Fracture which extends between the trochanters of the proximal femur
- lower limit is inferior border of lesser tuberosity
Extra capsular / well vascularized
The key to stability is the posteromedial cortex
Able to achieve relatively high level of function after STJ fusion
- previously believed that isolated STJ fusion should not be performed
- believed that triple arthrodesis was operation of choice for hindfoot
- STJ fusion has superior result with less stress on AJ
Average loss of DF 30% / PF 10%
Position of hindfoot determines flexibility of transverse tarsal (CCJ & TNJ) joints
- imperative that fusion be positioned in ~ 5o valgus
< 20o sagittal
< 30o coronal
< 3 cm of shortening