Fractures of the lower end of the tibia into the ankle-joint

Abstract

Eighty-two patients with 84 comminuted fractures of the lower end of the tibia involving the ankle-joint are reported. Open reduction as an emergency procedure, with anatomical reconstruction of the articular surface of the tibia combined with internal fixation was undertaken, observing the following four important operative principles:-1.Restoration of length and axis of the fibula (60 per cent) or of the tibia (40 per cent) as a first step.2.Reconstruction of the articular surface of the distal end of the tibia.3.Filling in of the defect resulting from impaction, using cancellous autografts.4.Support of the medial side of the tibia by plating to prevent a late varus deformity. After an average of 50 months to follow-up 74 per cent of the patients were free from pain and had good functional results. A secondary osteoarthritis does not necessarily occur in every case. The late functional result depends chiefly on the accuracy of the reconstruction that was achieved and on the immediate postoperative mobilization of the joint together with a period of 3-5 months free from weight-bearing. © 1969.