Distal tibial fracture: open reduction internal fixation with Stryker AxSOS 3 plate
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Spiral fractures of the distal tibia can pose a management challenge. Invariably, these are unstable injuries that a surgeon would struggle to manage by non-operative measures such as plaster casts or skeletal traction as achieving and maintaining a reduction is challenging. Moreover, patients do not tolerate the lengthy duration of above knee full casts or the recumbency required for skeletal traction. In addition, plain x-ray imaging reveals fracture extension into the ankle joint in about a third of all cases. Addition of CT assessment of the fracture pathoanatomy raises the appreciation of occult propagation of fracture lines into the ankle to 70%. Therefore, with these partial articular injuries (AO Foundation type 43B, see below), operative measures should be considered to achieve reduction and stability as well as restoring and preserving the articular surface.
In my opinion, I prefer internal fixation techniques that allow accurate reduction of the fracture pattern and, with the Stryker AxSOS 3 plating system, robust internal fixation using anatomically contoured plates. The Stryker distal tibial system has both medial and anterolateral plate conformations that provide surgeons with good treatment options for fixation of both extra-articular and intra-articular fractures of the tibia.
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Author: Mark Davies FRCS(Tr & Orth)
Institution: The Northern General Hospital, Sheffield, UK.
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