Management of ipsilateral distal tibia and ankle fractures

This study reviews 24 patients with ipsilateral fractures of the distal tibia metaphysis and ankle joint. All fractures were evaluated and categorized by the mechanism of injury--that is, bending force versus torsion. All--tibial fractures in this series were managed by a statically locked intramedullary nail with appropriate stabilization of the ankle injury as indicated by the fracture or injury pattern. This treatment protocol resulted in an excellent clinical result with only 3 patients requiring a secondary procedure: 2 dynamizations and 1 exchanged intramedullary nail. The results indicate that fibular fractures not involving disruption of the syndesmosis or minimally displaced distal fibular fractures may be treated nonoperatively. Conservative management or minimal internal fixation may be recommended for minimally displaced fractures of the medial malleolus or tibial plafond. Displaced fractures of the medial malleolus or distal fibula or fractures in which the syndesmosis has been disrupted are best treated with standard open reduction and internal fixation following placement of the intramedullary nail.