Skip to main content
SpringerLink
Log in

Surgical Management of Distal Tibial Fractures in Adults

  • Chapter
European Instructional Lectures

  • 1187 Accesses

Fractures of the distal tibia involve the diaphyse al- metaphyseal area of the bone, and may be either extra-articular or intraarticular, the latter known as pilon or plafond fractures. They are one of the most challenging injuries in orthopaedic traumatology [8, 17, 28, 30, 36, 52, 58, 68]. These fractures are considered severe injuries because of the elevated risk of com plications which may result from the nature of the injury itself, secondary to surgery, or both. For the past 20 years there have been a number of guidelines published as to the management of these injuries [1, 2, 4–7, 12, 15, 20, 21, 26, 51]. In addition, several surgical incisions in the operative management of these fractures have been recently described [2, 15, 26, 45]. The development of anatomically-contoured plates, along with angular stability, has helped considerably in obtaining stable fi xation in these diffi cult fractures. In spite of all this progress the clinical results are not always successful, and it is quite diffi cult to predict the fi nal outcome [3, 40, 52, 68].

As opposed to malleolar fractures which are secondary to a rotational injury, pilon fractures are secondary to axial compression of high energy. Morphologically, pilon fractures are differentiated from ankle fractures by the fact that the line of the fracture passes through the horizontal weight-bearing surface of the distal tibia. These two fractures have different mechanisms of injury and their treatment and outcome vary considerably. Thus, it is very important that they are classified and treated appropriately.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Anglen JO, Aleto T. Temporary transarticular external fi xation of the knee and ankle. J Orthop Trauma 1998; 12: 431–4.

    Article  PubMed  CAS  Google Scholar 

  2. Assal M, Ray A, Stern R. The extensile approach for the operative treatment of high-energy pilon fractures: surgical technique and soft-tissue healing. J Orthop Trauma 2007; 21: 198–206.

    Article  PubMed  Google Scholar 

  3. Babis GC, Vayanos ED, Papaioannou N, Pantazopoulos T. Results of surgical treatment of tibial plafond fractures. Clin Orthop Relat Res 1997; 341: 99–105.

    Article  PubMed  Google Scholar 

  4. Barbieri R, Schenk R, Koval K, Aurori K, Aurori B. Hybrid external fixation in the treatment of tibial plafond fractures. Clin Orthop Relat Res 1996; 332: 16–22.

    Article  PubMed  Google Scholar 

  5. Bartlett C, Weiner L. Fractures of the tibial pilon. In: Browner B, Jupiter J, Levine A, Trafton P, eds. Skeletal Trauma (3rd ed.), WB Saunders; Philadelphia, PA 2003: 2257–306.

    Google Scholar 

  6. Biga N, Laurent M, Thomine J. Fractures r écentes du pilon tibial de l ' adulte. Ost éosynth èse à foyer ferm é. Le fixateur externe avec ost éosynth èse a minima du tibia. Rev Chir Orthop 1992; 78 (suppl l): 57–8.

    Google Scholar 

  7. Blauth M, Bastian L, Krettek C, Knop C, Evans S. Surgical options for the treatment of severe tibial pilon fractures: a study of three techniques. J Orthop Trauma 2001; 15: 153–60.

    Article  PubMed  CAS  Google Scholar 

  8. B öhler L. Technique du traitement des fractures. Editions M édicales de France, Paris, 1944.

    Google Scholar 

  9. Bonar SK, Marsh JL. Unilateral external fixation for severe pilon fractures. Foot Ankle 1993; 14: 57–64.

    PubMed  CAS  Google Scholar 

  10. Bone L, Stegemann P, McNamara K, Seibel R. External fixation of severely comminuted and open tibial pilon fractures. Clin Orthop Relat Res 1993; 292: 101–7.

    PubMed  Google Scholar 

  11. Borens O, Kloen P, Richmond J, Roederer G, Levine DS, Helfet DL. Minimally invasive treatment of pilon fractures with a low profile plate: preliminary results in 17 cases. Arch Orthop Trauma Surg 2009; 129: 649–59.

    Article  PubMed  Google Scholar 

  12. Borrelli J, Jr., Catalano L. Open reduction and internal fixa-tion of pilon fractures. J Orthop Trauma 1999; 13: 573–82.

    Article  PubMed  Google Scholar 

  13. Brumback RJ, McGarvey WC. Fractures of the tibial plafond. Evolving treatment concepts for the pilon fracture. Orthop Clin North Am 1995; 26: 273–85.

    CAS  Google Scholar 

  14. Burgess AR, Dischinger PC, O'Quinn TD, Schmidhauser CB. Lower extremity injuries in drivers of airbag-equipped automobiles: clinical and crash reconstruction correlations. J Trauma 1995; 38: 509–16.

    Article  PubMed  CAS  Google Scholar 

  15. Chen L, O'Shea K, Early JS. The use of medial and lateral surgical approaches for the treatment of tibial plafond fractures. J Orthop Trauma 2007; 21: 207–11.

    Article  PubMed  Google Scholar 

  16. Collinge C, Kuper M, Larson K, Protzman R. Minimally invasive plating of high-energy metaphyseal distal tibia fractures. J Orthop Trauma 2007; 21: 355–61.

    Article  PubMed  Google Scholar 

  17. Colmar M, Langlais F. Complications pr écoces des fractures du pilon tibial avec rupture m étaphysaire totale. Rev Chir Orthop 1992; 78 (suppl I): 71–3.

    Google Scholar 

  18. Copin G, Nerot C. Les fractures du pilon tibial de l'adulte. Symposium SOFCOT. Paris, Nov 1991. Rev Chir Orthop 1992; 78 (suppl I): 33–83.

    Google Scholar 

  19. Court-Brown CM, Walker C, Garg A, McQueen MM. Half-ring external fixation in the management of tibial plafond fractures. J Orthop Trauma 1999; 13: 200–6.

    Article  PubMed  CAS  Google Scholar 

  20. DeLestang M, Hourlier H. Ost éosynth èse à foyer ouvert des fractures du pilon tibial. Traitement op ératoire par voie ant éro-exteme. Rev Chir Orthop 1992; 78 (suppl I): 54–6.

    Google Scholar 

  21. Dickson KF, Montgomery S, Field J. High energy plafond fractures treated by a spanning external fixator initially and followed by a second stage open reduction internal fixation of the articular surface-preliminary report. Injury 2001; 32 Suppl 4: SD92–8.

    PubMed  Google Scholar 

  22. Fitzpatrick DC, Marsh JL, Brown TD. Articulated external fixation of pilon fractures: the effects on ankle joint kinematics. J Orthop Trauma 1995; 9: 76–82.

    Article  PubMed  CAS  Google Scholar 

  23. French B, Tornetta P, 3rd. Hybrid external fixation of tibial pilon fractures. Foot Ankle Clin 2000; 5: 853–71.

    PubMed  CAS  Google Scholar 

  24. Giordano CP, Koval KJ. Treatment of fracture blisters: a prospective study of 53 cases. J Orthop Trauma 1995; 9: 171–6.

    Article  PubMed  CAS  Google Scholar 

  25. Griffiths GP, Thordarson DB. Tibial plafond fractures: limited internal fixation and a hybrid external fixator. Foot Ankle Int 1996; 17: 444–8.

    PubMed  CAS  Google Scholar 

  26. Grose A, Gardner MJ, Hettrich C, Fishman F, Lorich DG, Asprinio DE, Helfet DL. Open reduction and internal fixation of tibial pilon fractures using a lateral approach. J Orthop Trauma 2007; 21: 530–7.

    Article  PubMed  Google Scholar 

  27. Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am 1976; 58: 453–8.

    PubMed  CAS  Google Scholar 

  28. Hahn MP, Thies JW. Pilon tibiale fractures. Chirurg 2004; 75: 211–30.

    Article  PubMed  CAS  Google Scholar 

  29. Hasenboehler E, Rikli D, Babst R. Locking compression plate with minimally invasive plate osteosynthesis in dia-physeal and distal tibial fracture: a retrospective study of 32 patients. Injury 2007; 38: 365–70.

    Article  PubMed  CAS  Google Scholar 

  30. Heim V. Die pilon tibial fractur. Springer; Berlin, 1990.

    Google Scholar 

  31. Helfet DL, Shonnard P Y, Levine D, Borrelli J, Jr. Minimally invasive plate osteosynthesis of distal fractures of the tibia. Injury 1997; 28 Suppl 1: A42–7.

    Article  PubMed  Google Scholar 

  32. Hontzsch D, Karnatz N, Jansen T. One- or two-step management (with external fixator) of severe pilon-tibial fractures. Aktuelle Traumatol 1990; 20: 199–204.

    PubMed  CAS  Google Scholar 

  33. Hutson JJ Jr, Zych GA. Infections in periarticular fractures of the lower extremity treated with tensioned wire hybrid fixators. J Orthop Trauma 1998; 12: 214–8.

    Article  PubMed  Google Scholar 

  34. Kim HS, Jahng JS, Kim SS, Chun CH, Han HJ. Treatment of tibial pilon fractures using ring fixators and arthroscopy. Clin Orthop Relat Res 1997; 334: 244–50.

    Article  PubMed  Google Scholar 

  35. Lau TW, Leung F, Chan CF, Chow SP. Wound complication of minimally invasive plate osteosynthesis in distal tibia fractures. Int Orthop2008; 32: 697–703.

    Article  CAS  Google Scholar 

  36. Lecestre P, Lortat-Jacob A, Ramadier J. Les fractures du pilon tibial. Analyse de 40 cas et discussion. Ann Chir 1977; 31: 665–71.

    PubMed  CAS  Google Scholar 

  37. Lechevallier J, Biga N. Fixateur externe tibio-calcan éen dans le traitement des fractures du pilon tibial. Rev Chir Orthop 1988; 74: 52–60.

    PubMed  CAS  Google Scholar 

  38. Lee PT, Clarke MT, Bearcroft PW, Robinson AH. The proximal extent of the ankle capsule and safety for the insertion of percutaneous fine wires. J Bone Joint Surg Br 2005; 87: 668–71.

    Article  PubMed  CAS  Google Scholar 

  39. Marsh JL, Bonar S, Nepola JV, Decoster TA, Hurwitz SR. Use of an articulated external fixator for fractures of the tibial plafond. J Bone Joint Surg Am 1995; 77: 1498–509.

    PubMed  CAS  Google Scholar 

  40. Marsh JL, Buckwalter J, Gelberman R, Dirschl D, Olson S, Brown T, Llinias A. Articular fractures: does an anatomic reduction really change the result? J Bone Joint Surg Am 2002; 84-A: 1259–71.

    PubMed  CAS  Google Scholar 

  41. Marsh JL, Weigel DP, Dirschl DR. Tibial plafond fractures. How do these ankles function over time? J Bone Joint Surg Am 2003; 85-A: 287–95.

    PubMed  Google Scholar 

  42. McDonald MG, Burgess RC, Bolano LE, Nicholls PJ. Ilizarov treatment of pilon fractures. Clin Orthop Relat Res 1996; 325: 232–8.

    Article  PubMed  Google Scholar 

  43. Müller M, Nazarian S, Koch P, Schatzker J. The Comprehensive Classification of Fractures of Long Bones. Edited, Springer; Berlin, 1990.

    Google Scholar 

  44. Nordin J-Y, Barna L, Pages C, PlanteBordeneuve P. Ost éo-synth èse par fixateur externe de 35 fractures ouvertes et/ou comminutives de la cheville. Rev Chir Orthop 1988; 74 (suppl II): 230–3.

    PubMed  Google Scholar 

  45. Nork SE, Schwartz AK, Agel J, Holt SK, Schrick JL, Winquist RA. Intramedullary nailing of distal metaphyseal tibial fractures. J Bone Joint Surg Am 2005; 87: 1213–21.

    Article  PubMed  Google Scholar 

  46. Pai V, Coulter G. Minimally invasive plate fixation of the tibia. Int Orthop 2007; 31: 491–6.

    Article  PubMed  Google Scholar 

  47. Paiement G, Gosselin R, Contreras D. Traitement par fixa-tion interne minimale et fixation externe des fractures complexes du pilon tibial. 38e Congr ès de l'AOLF, Qu ébec. Rev Chir Orthop 1992; 79: 145–71.

    Google Scholar 

  48. Papadokostakis G, Kontakis G, Giannoudis P, Hadjipavlou A. External fixation devices in the treatment of fractures of the tibial plafond: a systematic review of the literature. J Bone Joint Surg Br 2008; 90: 1–6.

    PubMed  CAS  Google Scholar 

  49. Parameswaran AD, Roberts CS, Seligson D, Voor M. Pin tract infection with contemporary external fixation: how much of a problem? J Orthop Trauma 2003; 17: 503–7.

    Article  PubMed  Google Scholar 

  50. Patterson MJ, Cole JD. Two-staged delayed open reduction and internal fixation of severe pilon fractures. J Orthop Trauma 1999; 13: 85–91.

    Article  PubMed  CAS  Google Scholar 

  51. Plaweski S, Abu M, Butel J, Faure C. Ost éosynth èse à foyer ouvert des fractures du pilon tibial: Techniques classiques. Rev Chir Orthop 1992; 78(suppl I): 51–4.

    Google Scholar 

  52. Pollak AN, McCarthy ML, Bess RS, Agel J, Swiontkowski MF. Outcomes after treatment of high-energy tibial plafond fractures. J Bone Joint Surg Am 2003; 85-A: 1893–900.

    PubMed  Google Scholar 

  53. Pugh KJ, Wolinsky PR, McAndrew MP, Johnson KD. Tibial pilon fractures: a comparison of treatment methods. J Trauma 1999; 47: 937–41.

    Article  PubMed  CAS  Google Scholar 

  54. Redfern DJ, Syed SU, Davies SJ. Fractures of the distal tibia: minimally invasive plate osteosynthesis. Injury 2004; 35: 615–20.

    Article  PubMed  CAS  Google Scholar 

  55. Rüedi T, Allgöwer M. Fractures of the lower end of the tibia into the ankle joint: results 9 years after open reduction and internal fixation. Injury 1973; 5: 130–4.

    Article  PubMed  Google Scholar 

  56. Rüedi T, Matter P, Allg öwer M. Die intraartikularen frac-turen des distalen unterschentekendes. Helv Chir Acta 1968; 35: 556–82.

    PubMed  Google Scholar 

  57. Samaran P, Bonnevialle P, Copin G, Murga R. Fractures r écentes du pilon tibial de l'adulte. Ost éosynth èse à foyer ferm é. Fixateur externe d'Ilizarov et fracture du pilon tibial. Rev Chir Orthop 1992; 78 (suppl I): 59–60.

    Google Scholar 

  58. Siguier M, Pacault J-Y, Judet T, Brumpt B: Fractures du pilon tibial. In: Actualit és de chirurgie orthop édique de l'h ô pital Raymond-Poincar é. Masson, Paris, 1978, 34–47.

    Google Scholar 

  59. Sirkin M, Sanders R, DiPasquale T, Herscovici D, Jr. A staged protocol for soft tissue management in the treatment of complex pilon fractures. J Orthop Trauma 1999; 13: 78–84.

    Article  PubMed  CAS  Google Scholar 

  60. Strauss EJ, Alfonso D, Kummer FJ, Egol KA, Tejwani NC. The effect of concurrent fibular fracture on the fixation of distal tibia fractures: a laboratory comparison of intramedullary nails with locked plates. J Orthop Trauma 2007; 21: 172–7.

    Article  PubMed  Google Scholar 

  61. Summer C, Rüedi T. Tibia: distal (pilon). In: Rüedi T, Murphy W, eds. AO Principles of Fracture Management. Thieme; Stuttgart, 2000: 539–56.

    Google Scholar 

  62. Tornetta P, 3rd, Gorup J. Axial computed tomography of pilon fractures. Clin Orthop Relat Res 1996; 323: 273–6.

    Article  PubMed  Google Scholar 

  63. Tornetta P, 3rd, Weiner L, Bergman M, Watnik N, Steuer J, Kelley M, Yang E. Pilon fractures: treatment with combined internal and external fixation. J Orthop Trauma 1993; 7: 489–96.

    Article  PubMed  Google Scholar 

  64. Tscherne H, Gotzen L. Fraktur und Weichteilschaden. Springer; Heidelberg, 1983.

    Google Scholar 

  65. Tscherne H, Oestern H: Pathophysiology and classification of soft tissue injuries associated with fractures. In: Tscherne H, Gotzen L, eds. Fractures with Soft Tissue Injuries: Springer; Berlin, 1984: 1–9.

    Google Scholar 

  66. Varela CD, Vaughan TK, Carr JB, Slemmons BK. Fracture blisters: clinical and pathological aspects. J Orthop Trauma 1993; 7: 417–27.

    Article  PubMed  CAS  Google Scholar 

  67. Vidal J, Terschiphorst P, Molhy A, Maury P, Boisard J, Martin B. Ligamentotaxis. M éthode de r éduction et de contention des fractures articulaires complexes. Rev Chir Orthop 1990; 76: 90–9.

    Google Scholar 

  68. Vives P, Hourlier H, DeLestang M, Dorde T, Letot P, Senlecq F. Etude de 84 fractures du pilon tibial de l'adulte. Essai de clas-sification. Rev Chir Orthop 1984; 70: 129–39.

    PubMed  CAS  Google Scholar 

  69. Vrabl M. Primary closed, stabilisation of type C 3 pilon fractures with external fixator without bridging the ankle joint. Unfallchirurg 1997; 100: 406–8.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Orthopaedic Surgery Service, University Hospital of Geneva, Switzerland

    Mathieu Assal & Richard Stern

Authors
  1. Mathieu Assal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Richard Stern
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Royal National Orthopaedic Hospital Trust, Stanmore, Middlesex, HA 7 4LP, UK

    George Bentley

Rights and permissions

Reprints and permissions

Copyright information

© 2009 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Assal, M., Stern, R. (2009). Surgical Management of Distal Tibial Fractures in Adults. In: Bentley, G. (eds) European Instructional Lectures. European Federation of National Associations of Orthopaedics and Traumatology, vol 9. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-00966-2_12

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-00966-2_12

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-00965-5

  • Online ISBN: 978-3-642-00966-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation