[Distal tibial fractures].

Distal tibial fractures can be divided by mechanism into injuries caused by torsion trauma or by compression trauma. The latter ones are often associated with a complete destruction of the tibial joint surface, so-called tibial plafond fractures. Another group of fractures are the distal metaphyseal fractures of the tibia with only minimal involvement of the ankle as a result of low energy torsion trauma. Multiple factors can be held responsible for posttraumatic complications and poor outcome: malalignment, nonanatomic reduction of the joint surface or bone defects, and severe soft tissue injury. Therefore a sophisticated therapeutic regime of distal tibial fractures is necessary, which we present in detail in this article. In cases with only minor soft tissue injury a primary definitive open reduction internal fixation (ORIF) of the tibial fracture is possible. Fractures with severe soft tissue injury should be initially fixed with an external fixator. Definitive fixation and reconstruction should here be performed in subsequent operations. Early functional therapy can be attempted if fractures are reliably stabilized.