Surgical Treatment of Closed Tibial and Fibular Fractures

A 63-year-old male patient (height 180cm, weight 95 kg) suffered from a closed fracture of the lower leg with a distal diaphyseal fracture of the tibia, a proximal and a distal fibular fracture (Figure 1A). Computed tomography (CT) scans of the injured lower leg and the ankle joint were taken upon admission, and immediate Damage Control surgery was conducted on the day of the accident by closed reduction and the application of an ankle-joint-crossing, external fixator overspanning the fracture gap. After consolidation of the soft-tissue injury, the tibial fracture was surgically treated by implantation of an intramedullary nail (9 × 345 mm, Expert, Synthes, Umkirch, Germany). The distal fibular fracture was treated by open reduction and plate osteosynthesis (VariAx 2 Distal fibula system, Stryker, Kalamazoo, USA) including restoration of a syndesmotic injury by using a set screw, whereas the proximal fibular fracture was not treated surgically (Figure 1B). Postoperatively, the patient was mobilized on forearm crutches with a partial weight-bearing recommendation of 20 kg for the first 6 weeks (Figure 1C). A postoperative CT scan early after surgery and follow-up radiographs at 6 weeks and approximately 6 months after surgery were taken.