[Changes and progress in fracture treatment of the proximal and distal lower leg]

In the treatment of proximal and distal tibial fractures, special attention has to be focused on the severity of tissue damage. Guidelines are given in the paper. (1) For tibial head fractures, stable internal fixation is usually necessary but should be delayed for 1 week. The best approach is lateral or ventral. The use of implants for buttressing has to be kept to a minimum. Concomitant ligamentous injuries are reconstructed, and damaged menisci should be preserved. (2) In the case of distal tibial fractures, those not involving the joint can be treated non-operatively. The internal fixation method by Ruedi is rarely indicated. When joint fractures involve tissue damage reconstruction is necessary. It is essential to achieve normal length of fibula. The joint is reconstructed with minimal use of implants. In addition, external fixation is usually necessary.