Posterolateral Plating of Distal Tibia Fractures: Extending the Use of a Familiar Approach

Distal tibia fractures present challenges in surgical management and when nailing is not an option, plate osteosynthesis is performed. This is usually done with a minimally invasive approach to reduce the risk of wound complications in an already fragile soft-tissue envelope. We propose that a posterolateral open approach can lead to stable fixation construct and comes with advantages of approaching fibula fractures via same approach and has a thicker soft tissue envelope over the fixation. We report a series of distal tibia fractures with posterolateral plate fixation and present the outcomes.

This is a retrospective review conducted at a single institution, where 13 patients underwent posterolateral approach for distal tibia fracture fixation. Where required, medial plating and fibular fixation was additionally performed. Patients were followed-up with primary endpoint of successful clinical and radiological union or complications required re-intervention. Operative and long-term clinical outcomes were recorded.

Long term follow-up was available for 12 patients. There was 1 non-union requiring revision (8.3%). For the other patients, clinical union occurred by 14.5 weeks and radiological union by 20 weeks on average. There was no malunion and 2 patients (16.6%) underwent removal of implants for symptoms of hardware irritation.

We found that outcomes in our cohort demonstrate posterolateral plating is safe as a primary or adjunctive method of fixation, and does not compromise other outcomes when compared with traditional fixation methods.