The operative treatment of intra-articular fractures of the lower end of the tibia

Intra-articular fractures of the lower end of the tibia are an interesting challenge. The best functional results in the past series were observed in patients treated according to the following 4 sequential principles: (1) reconstruction of the correct length of the fibula; (2) anatomical reconstruction of the articular surface of the tibia; (3) insertion of a cancellous autograft to fill gaps left by impaction and comminution; (4) stable internal fixation of the fragments by a plate placed on the medial aspect of the tibia. Seventy-five cases had a good or excellent late result (on average 6 years postoperatively) in 70% as compared to 43% to 55% in cases treated by closed and/or open methods.