Authors of section


Richard Buckley, Andrew Sands


Martin Hessmann, Sean Nork, Christoph Sommer, Bruce Twaddle

Executive Editors

Joseph Schatzker, Peter Trafton, Michael Baumgaertner

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Extraarticular, multifragmentary fracture

These distal tibial nonarticular metaphyseal fractures can be described by their increasing degree of complexity as:

  • Having 3 intermediate fragments (classified by AO/OTA as 43A3.1)
  • Having more than 3 intermediate fragments (classified by AO/OTA as 43A3.2)
  • Having fragments extending into the diaphysis (classified by AO/OTA as 43A3.3)

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.

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