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Scolaro, John A. MD, MA; Donegan, Derek J. MD; Mir, Hassan R. MD, MBA, FACS

Journal of Orthopaedic Trauma: November 2016 - Volume 30 - Issue - p S1
doi: 10.1097/BOT.0000000000000696

*Department of Orthopaedic Surgery, University of California, Irvine, Orange, CA;

Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA;

University of South Florida, Tampa, FL; and

§Florida Orthopaedic Institute, Tampa, FL.

J. A. Scolaro: consultant for Smith & Nephew, Stryker, and Globus Medical. D. J. Donegan: consultant for Synthes. H. R. Mir: paid consultant for Smith & Nephew and paid speaker for Depuy-Synthes.

The management of distal tibia fractures continues to evolve. Historically, open reduction and internal fixation with a plate and screw device was performed, especially if a concurrent distal intraarticular plafond injury was present. A growing body of literature has evaluated the advantages and disadvantages of not only open reduction and internal fixation for distal tibia fractures but also fixation with intramedullary nails and thin wire ring fixators. Studies have shown that fracture malalignment and nonunion, as well as soft tissue complications, are not uncommon and can occur regardless of the fixation modality chosen. Advancements in both orthopaedic implants and surgical techniques have improved and broadened our means of treating these injuries.

The purpose of this supplemental issue is not only to present and review the current evidence on the management of distal tibia fractures but also provide the reader with information and techniques that are relevant to the management of these injuries. We have assembled experienced and knowledgeable authors to help accomplish this goal. The lead article presents the current evidence on plate versus nail fixation of these injuries and introduces the pertinent issues that surround each. The following articles include a “tips and tricks” piece focused on successful treatment of distal tibia fractures with an intramedullary nail, an article on the use of tibial nails for for fixation of injuries that have fracture extension into the articular surface of the distal tibia, the use of concurrent plates and nails for difficult distal tibial injuries, an analysis of concomitant fibular fixation during tibial nail or plate fixation and finally, the use of circular fixators as an alternative approach for management of these injuries.

Unlike diaphyseal tibia fractures, fractures of the distal tibia are subject to a completely different set of challenges. This is due to the deforming muscular forces of the lower leg, proximity to the ankle joint and the soft tissue envelope. Although some literature exists on the topic, controversies and questions still remain, requiring further analysis and discussion. We intend for this collection of articles to encourage continued investigation and research on the topic.

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