Introduction: High energy tibial pilon fractures are usually associated with a significant bone loss in the metaphyseal area of the tibia. This study evaluates three different treatment options for the management of the metaphyseal bone loss.

Materials and Methods: Betwwen 1996 and 2007, 85 high energy pilon fractures- Ovadia Beals type IV: 39 and V: 46- were treated and reviewed in our institution. Twenty four fractures were open, and fifty one closed fractures had soft tissue lesion grade1 or 2 according to Tscherne classification. To restore the bone continuity in tibia metaphyseal area bone graft substitutes were used in 53 fractures, acute shortening and proximal lengthening in 18 fractures and bone transport in 14 fractures. Evaluation was carried out according to the Ovadia-Beals evaluation system.

Results: The mean average follow up was 6 years. Thirty seven fractures (70%) treated with bone graft substitutes achieved an excellent or good result. Eleven fractures (61%) treated with proximal tibia lengthening achieved an excellent or good result, whereas only eight fractures (57%) treated with bone transport achieved an excellent or good. Bone infection was recorded in 6 fractures, all in the group of the patients treated with bone graft substitutes.

Conclusion: The management of the metaphyseal bone loss in the high energy tibial pilon fractures is a basic priority to achieve a satisfactory result. Hybrid external fixation with the use of bone graft substitutes seems to be a more suitable technique to these devastating injuries. However bone infection remains a major concern for these devastating injuries.

Purpose: To evaluate the efficacy of intramedullary nailing for the treatment of the fractures of the proximal quarter of the tibia with special respect on the reduction accuracy.

Patients: This is a retrospective study which was conducted in our institution between October 2004 and March 2007. 30 extrarticular proximal tibia fractures were treated with intramedullary nailing. The mean age of the patients was 27 years (19 to 47). Seven fractures (23%) were open – Gustillo grade I-, twelve fractures (12%) had segmental comminution and six (6%) were bifocal fractures. Static intramedullary nailing was chosen in all cases. Distal dynamization was performed routinely in all fractures at an average of 7 weeks (6 to 12 weeks) after the primary operation. Union of the fracture and the accuracy of the reduction were assessed clinically and radiologically.

Results: The average follow up was 16 months (9 to 22). All fractures united without additional procedures. Acceptable alignment was obtained in 28 of 30 fractures (93%). Postoperative angulation was satisfactory (average frontal and sagittal plane deformity of less than 2 degrees) in 26 fractures (87%). Two patients had frontal plane deformities (one 4° varus and one valgus 7°) and two patients had a saaggital plane deformities (7° procuvartum). No significant complication was recorded.

Conclusions: The proximity of the upper tibia fracture to the knee makes the treatment of these fractures more challenging. Closed intramedullary nailing combined with special reduction technique is a safe and effective method of managing of the proximal tibia fractures.

Purpose. To assess the efficacy of the treatment of the aseptic hypertrophic nonunion of the tibia and the secondary deformities by distraction-osteogenesis.

Material Methods: Between 1998 and 2006, 28 patients with a hyperthrophic tibia nonunion were treated by distraction or compression-distraction depending on the mobility of the nonunion. The mean age of the patients was 37.5 years (range 24 to 68) and the average number of previous surgeries on the affected limb was 2 (from 1 to 4). No active bone infection or history of infection was recorded in this series. Closed distraction was applied in 11 patients, closed distraction – compression in 8 and osteoclasis following by distraction in 9 patients. In all cases an external fixation device (19 circular, 11 monolateral external frames) modified to meet the nonunion requirements was used.

Results: Distraction or distraction-compression resulted in solid union in all patients (mean time to union 8.4 months, mean follow up 5 years). The external fixator remained in place for an average of 8.2 months (range 7 to 11.5 months). Mean leg length discrepancy 2.5 cm and mean angular deformity 12° were also corrected on the same procedure

Conclusions: Treatment of the tibia nonunion by callus distraction or distraction – compression leads to successfully results. The procedure and the frame have to be individualized according to the nonunion pathology and the secondary tibia deformities.