plate

Definition

Metaphysical

Extra-articular

Treatment options

IMN

Plate

Results

Jindal et al. Indian J Orthop 2020

- systematic review

- no different in malunion

- infection more common in plate

Distal Tibial Fractures

Definition

Metaphyseal

Extra-articular

Intra-articular Extension

AO Classification

Types

1. Supracondylar

2. Unicondylar

3. Intracondylar

Xrays

Supracondylar / Extra-condylar

Epidemiology

Most common long bone fracture

Aetiology

Young patients / sports

Elderly / simple falls

MVA - often compound

Tscherne Soft Tissue Classification

Grade 0

- nil ST injury

Grade 1

Epidemiology

2 groups

1.  Elderly

- low velocity injury

- osteoporotic

- need to start bisphosphonates

2.  Young patients

- high velocity injury

Anatomy

Distal Radius Angles

- radial volar tilt 11°

- radial inclination  22°

- radius is 11 mm longer than ulna 

- ulna variance 2mm positive on average

Epidemiology

>65

Third most common fracture after hip and distal radius

Anatomy

Neck shaft angle 130^o

Head retroverted 20^o relative to shaft

Anatomical neck (junction of head and metaphysis)

Non operative Management

Indications

< 20^o sagittal

< 30^o coronal

< 3 cm of shortening

Options

Definition

Intra-articular proximal ulna fracture

Anatomy

Articulates with trochlea

- may have a central bare area

Triceps insertion

- via broad aponeurosis which blends with anconeus and CEO

Management

Non operative Management

Undisplaced fracture

- need to ensure triceps mechanism is intact

Ossification

Primary

- 8 / 52 gestation radius & ulna

Secondary

- distal radius age 1

- distal ulna age 5

Non Operative Management

Unacceptable Position

< 10:  > 15^o malalignment

> 10:  > 10^o malalignment

Postreduction Positionin / Rule of Thirds