The injury
A high-energy fracture of the weight-bearing surface of the distal tibia, typically following a fall from height or a road traffic collision. The articular surface is often multifragmentary and the overlying soft tissues are frequently compromised.
Why treatment is staged
Operating through swollen or contused skin carries a substantial risk of wound breakdown and deep infection. The first procedure, undertaken within a day or two, is commonly a spanning external fixator that restores length and allows the soft tissues to settle. Definitive fixation follows once the skin wrinkle sign has returned, usually after seven to fourteen days.
Definitive fixation
A CT scan is used to map the fragments. The articular surface is reconstructed and supported with anatomically contoured medial and anterolateral tibial plates, with fibular fixation where indicated. Limited incisions are used where the fracture pattern allows.
Recovery
Recovery is longer than after an isolated ankle fracture: typically six weeks non-weight-bearing and a boot until approximately twelve weeks. Some residual stiffness is to be expected and physiotherapy is an important determinant of the final result. Post-traumatic arthritis may develop in later years; this is discussed before surgery.
Arranging an appointment. Private patients are seen at King Edward VII's Hospital, The London Clinic, Cromwell Hospital and HCA Healthcare at The Shard. NHS patients are seen at King's College Hospital.
Call 020 7046 8004 or send an enquiry.
Radiographs are from my own practice, reproduced uncropped with identifying details removed. This page provides general information and is not a substitute for individual assessment.