Distal tibial fracture (fracture in the distal articular surface of the proximal tibia within 5cm) incidence is relatively low, only a small portion of all lower limb fractures. When the fracture involves the articular surface of the tibia, also known as time-distance Pilon fracture, or tibial dome (plafond) fractures. About 75% of Pilon fracture combined with fibula fracture. It is often caused by a high-energy injure or multiple injuries, which is hard to deal with, often combined with soft tissue necrosis, infection, nonunion, and traumatic arthritis and other complications.
Conservative treatment
1. Indications: fractures without displacement; maintain normal articular surface; poor general condition; difficult to tolerate surgery.
2. Method: manual reduction, splint or cast immobilization.
Surgical treatment
1. Indications: fracture displacement, intercalation defect; articular surface irregularities greater than 2mm; with neurovascular injury; appears rotational deformity can not be corrected.
2. Surgical Method: open reduction and internal fixation, external fixation.
1. High-protein, high-calorie, high vitamin diet to promote healing.
2. Promote venous return.
3. within 24 hours after fixed by plaster, we should always check dorsiflexion and toe flexor case to determine whether the peroneal nerve is compressed, if the suspect nerve compression, plaster should be broken immediately for decompression.
4. After the small splint, closely observe numbness, pain and other symptoms of limb tightness, to prevent local pressure sores, limb necrosis and other complications.
5. 0-3 days after surgery for early functional exercise, such as ankle dorsiflexion flexor exercise.
6. 2-3 weeks after surgery, no weight-bearing limb activities in bed, such as the knee, ankle and foot of a small joint active flexion exercise, income hip abduction exercises using traction bed arm activities, exercise, training arm strength, so that when you come down to earth with a crutch.
7. After 3 Week - 3 month crutches out of bed to partial weight bearing activity gradually over the limb which is form no weight-bearing activities, to full weight-bearing.
