Fractures of the Lower End of the Tibia into the Ankle-Joint

Outcomes of 84 comminuted distal tibia fractures in 82 patients treated by open reduction and internal fixation were reported. The operative procedure sought to restore bone length and correct axis, reconstruct the articular surface of the distal end of the tibia, fill defects, and prevent late varus deformity. Pain-free status with good functional results was achieved in 74% of the patients, and those with better anatomical restoration had better functional results. Although there was agreement that fractures involving joints should be surgically treated to restore joint function, distal tibia fractures with comminution of the joint were commonly regarded as too complex to anatomically restore. The conventional wisdom of the time held that fixation was futile as the results would not be successful in any case. However, using the most current operative methods for open reduction and internal fixation, and with care for minimizing the risk of infection, this study sought to establish whether anatomical restoration of the ankle joint would achieve better late results than anticipated.