Tibia and fibula, distal

10.1055/b-0034-87660

Tibia and fibula, distal

Classification

The Müller AO Classification 546

Introduction

21.1 Tibia and fibula, distal—introduction Christoph Sommer, Rodrigo Pesantez 547
1 Introduction 547
1.1 Incidence 547
1.2 Current methods of treatment 547
1.3 Indications and contraindications for MIPO 548
2 Surgical anatomy 548
3 Preoperative assessment 549
3.1 Soft tissues 549
3.2 Imaging 549
3.3 Preoperative planning 549
4 Operative procedure 549
4.1 General principles 550
4.2 Patient and image intensifier positioning 551
4.3 Surgical approach 552
4.4 Reduction and fixation 553
5 Further tips and tricks 558
5.1 Assessment of reduction 558
5.2 Syndesmotic injury 558
5.3 Prevention of nonunion in simple fractures 558
6 Pitfalls 560
7 Pearls 561
8 References 561
9 Further reading 562

Cases

21.2 Tibia and fibula, distal: extraarticular unifocal fracture of the distal tibia—42-A1, in combination with a multifragmentary fracture of the distal fibula—44-C2 Christoph Sommer 563
21.3 Tibia and fibula, distal: intraarticular simple fracture of the distal tibia—43-C1 with multifragmentary fracture of the distal fibula Christoph Sommer 569
21.4 Tibia and fibula, distal: intraarticular complex fracture of the distal tibia—43-C3 with multifragmentary fracture of the distal fibula Christoph Sommer 577
21.5 Tibia and fibula, distal: extraarticular multifragmentary distal tibial fracture—43-A3 in combination with a multifragmentary distal fibular fracture Apipop Kritsaneephaiboon 585

Classification

The use of the AO Müller Classification of distal tibial fractures is important to determine their prognosis and choose the most appropriate treatment. Fractures of the distal tibia occur with or without involvement of the articular surface of the ankle joint. According to the Müller AO Classification, fractures of the distal tibia are divided into three groups: 43-A extraarticular fractures, 43-B partial articular fractures, and 43-C complete articular fractures.

A special type of injury of the distal tibia caused by a rotational injury is characterized by involvement of the tibiofibular syndesmosis in association with a posterolateral fracture component of the distal tibia (Volkmann) (see chapter 21.1 Tibia and fibula, distal—introduction, 5.2 Syndesmotic injury, Fig 21.1-20 ). This fracture is best classified as a combination type injury:

Extraarticular fracture of distal tibia (metadiaphyseal junction) 42 or 43, and
Ankle fracture 44-B- or C-type. It accounts for about 10–15% of all distal tibial fractures.