European Journal of Molecular & Clinical Medicine

Background:Distal tibial fractures can be divided by mechanism into injuries caused by torsion
trauma or by compression trauma. The latter ones are often associated with a complete
destruction of the tibial joint surface, so-called tibial plafond fractures. Another group of
fractures are the distal metaphyseal fractures of the tibia with only minimal involvement of the
ankle as a result of low energy torsion trauma. Multiple factors can be held responsible for
posttraumatic complications and poor outcome: malalignment, nonanatomic reduction of the
joint surface or bone defects, and severe soft tissue injury. Therefore, a sophisticated
therapeutic regime of distal tibial fractures is necessary, which we present in detail in this
article. In cases with only minor soft tissue injury a primary definitive open reduction internal
fixation (ORIF) of the tibial fracture is possible. Fractures with severe soft tissue injury should
be initially fixed with an external fixator. Definitive fixation and reconstruction should here be
performed in subsequent operations. Early functional therapy can be attempted if fractures are
reliably stabilized.Blocking or “Poller” screws are a particularly useful technique to help guide
the nail correctly. This technique involves placing a blocking screw, drill bit, or K-wire to force
the reamer and then the nail into the proper path.The screw can be left in place to increase
stability which may be particularly useful in geriatric fractures with wider tibiae and poorer
bone quality.