In these fractures, the articular surface fracture is two-part, but the metaphyseal fracture is multifragmentary. They can be further described as:
Multifragmentary with asymmetric metaphyseal impaction (classified by AO/OTA as 43C2.1). This leads to tilting of the articular surface.
Multifragmentary without asymmetric impaction (classified by AO/OTA as 43C2.2).
Multifragmentary extending into the diaphysis (classified by AO/OTA as 43C2.3).
Standard AP and lateral x-rays are taken. More detailed information is provided by CT-scans with 2-D and 3-D reconstructions.
Clinical assessment must include the condition of the soft tissues as well as the sensory and motor function of the foot structures. Special attention is given to any signs of a compartment syndrome. Standard AP and lateral x-rays are taken. In case of doubt, CT-scans may be helpful to detect or exclude involvement of the articular surface. For all distal tibia fractures, the fibula must be classified as intact, or fractured into two or multiple fragments.