Ipsilateral tibia and ankle fractures

This study reports on 18 cases of diaphyseal fractures of the tibia associated with ipsilateral but not contiguous ankle fractures. Thirteen of these complex fractures resulted from low-energy torsional forces, while five were caused by high-energy impact. Definitive treatment consisted solely of cast immobilization in four; 14 had operative stabilization of each fracture component. Of these 14, four patients were treated initially in long leg casts and one in a plaster splint, but each required surgical intervention to control fracture alignment. The average follow-up time was 21.2 months. In the nonoperative group of four patients, clinically significant shortening and/or rotational deformity were noted in three limbs, with ankle mobility decreased by > 50% and advanced posttraumatic arthritis evident in two ankles. Of the cases managed operatively, 10 (71%) had full structural and functional recovery, three patients regained only 75% of ankle mobility, and two patients developed slight valgus deformities, one with a concomitant rotational deformity of less than 10 degrees. These findings demonstrate the unstable nature of this complex fracture pattern and the advantages of operative management.