Principles of Treatment: restoration of fibular length, anatomic reduction of tibial articular surface, bone grafting of metaphyseal defects, medial buttress plating to prevent varus
Treatment: initial fixation of the fibula with temporary spanning external fixation with delayed conversion to internal fixation when soft tissues permit, generally 14-21 days. CT scan should be performed in traction for pre-op planning. See Pilon ORIF / Ex Fix Technique.
Closed fractures may be placed in calcaneal traction and a Bohler-Braun frame.
Open fractures/compartment syndromes should be taken to OR for external fixation / fasciotomy. Consider 2-pin traveling traction. (one 6mm centrally threaded calcaneal pin and one proximal tibia pin at level of the fibular head with quadrilateral frame.)
AO comprehensive Classification of Fractures of long Bones
Ruedi Allgower Classification (Ruedi TP, Allgower M CORR 1979;138:105).
Type A=extra-articular=@92% good/excellent results, Type B=partial articular=@85% good/excellent results, Type C=complete articular=@60% good/excellent results
poor results associated with high-grade soft-tissue injury, >2mm articular incongruency, malalignment of mechanical axis >5degrees
Reudi-Allgower Classification: Type I & II = 86% excellent to good results nonuniomn =7%, malunion=3%, wound dehiscence=17% Type II&III high energy=wound problems and deep infection uto 37%, malunion=23%, nonunion=27%. Tscherne grades 0 or 1 best treated with AO/ASIF technique plating, femoral distractor often helpful for indirect reduction.
Tsherne 2 & 3 and open fx best treated with limited open fixation(olive wires/canulated screws) for articular reduction and small wire circular external fixation.