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26 Jul 2025
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Intra-articular Distal Tibia Fracture from Torsional Mechanism (Not a Pilon Fracture)

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Clinical Details

Clinical and radiological findings:  A 54-year-old male sustained an intra-articular distal tibia fracture following a fall while skateboarding. The injury mechanism was torsional rather than axial, resulting in minimal joint injury. Initial radiological assessment confirmed the presence of an intra-articular fracture without significant soft tissue compromise.

Preoperative Plan

Planning remarks:  The preoperative plan involved anatomical reduction and interfragmentary compression of the fracture fragments. An anterolateral approach was planned to access and reduce the Chaput fragment, complemented by a limited posteromedial approach at the level of the medial apex for additional reduction.

Surgical Discussion

Patient positioning:  Supine positioning was utilized for the procedure, allowing optimal access to both the anterolateral and posteromedial aspects of the distal tibia.

Anatomical surgical approach:  The surgical approach commenced with an anterolateral incision, providing access to the Chaput fragment. This was followed by a limited posteromedial incision at the level of the medial apex to facilitate reduction of the posteromedial fragment.

Operative remarks: 

The surgeon noted that despite the fracture not being classified as a pilon due to its torsional mechanism, the treatment strategy remained consistent with that of a pilon fracture. Anatomical reduction and interfragmentary compression were achieved through the dual approach, ensuring stability and alignment of the fracture fragments.

Postoperative protocol:   Postoperative rehabilitation included early mobilization with protected weight-bearing as tolerated, progressing to full weight-bearing over a period of weeks, contingent on radiological evidence of healing.

Follow up:   Not specified

Orthopaedic implants used:   Interfragmentary screws, plate fixation (specific type not specified).

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