Distal Tibia Fracture- What is the ideal treatment plan?

Should I choose Nailing or Plating technique?

A 52 YO male, visited ER with swelling & pain on the right leg. He had RTA on the same day.

What is the ideal treatment plan?

PRE-OP X-RAY

• Ideal line of management of distal tibial spiral fractures includes Computed Tomograph of the ankle joint to look for intraarticular extension of the fracture and/ or fracture of the posterior malleolus.
• Studies have demonstrated the importance of CT scan in detecting previously unreported injuries as seen on plain radiographs.

• However, in this scenario no CT scan were done, lateral view on plain radiograph demonstrated fracture line extending to intraarticular region (marked by yellow arrow)

Should I choose nailing or plating?

• In this case, Plating by MIPPO technique was used
• We have included two notable findings, which need to be addressed regarding surgical decision about the mode of fixation and their outcomes as noted in the recent studies.

• Procedure done by MIPPO technique using GPC fixLOCK Anteromedial distal tibial plate (without tab).
• Lag screw placement to achieve fracture reduction and fixation.
• Lag screw placed directly perpendicular to fracture site apart from plate construct.
• Second lag screw placed through the combi hole of the locking plate.
• We recommend treatment as per AO principles of fracture fixation with anatomical reduction of the intraarticular fracture, soft tissue handling (fracture environment), preserving blood supply, and early restoration of function.