Tony G. Pedri


Orthopaedic surgeons on-call often see patients with fractures of the distal tibia involving the articular surface, with extension proximal into the metaphysis, or intraarticular distal tibia fractures. These injuries pose unique challenges owing to the typical highenergy mechanism, articular-surface involvement, high degree of comminution, and typically large soft-tissue injury. Treatment has evolved greatly with the advent of modern fracture-fixation techniques and implants. However, a large percentage of patients continue to report poor subjective outcomes. Nearly all of these patients develop posttraumatic arthritis, with the most severe often requiring further reconstructive or fusion procedures once healed to treat the symptoms. Recent studies have described promising outcomes after treating certain fractures (eg, Lisfranc and subtalar) with primary fusion of the affected joints as the definitive method of fixation. Subsequently, there is increased interest in treating severe intraarticular distal tibia fractures with primary fusion of the tibiotalar joint. Few studies have reported on this topic, yet several case reports and small series of patients found successful outcomes with primary fusion. The purpose of this paper is to provide a brief review of intraarticular distal tibia fractures and primary fusion, covering reported treatment methods and outcomes. Although primary fusion may be a viable option in improving patient outcomes in certain fracture patterns and patients, more long-term studies comparing methods are needed to help surgeons decide definitive treatment.

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