I see AP, Lateral and oblique views of left leg and ankle, with comminuted and displaced I/A fracture of distal tibia with metaphysical extension. I would like to know the MOI, age and comorbidities.
I will approach the patient using ATLS principles. Once life threatening injuries are excluded, I will ensure that the injury is isolated, closed, NV intact and there is no compartment syndrome and assess the soft tissue for superficial/ deep abrasions or crushing.
I would like like to see the full length view of the tibia and fibula. I will give adequate analgesia, reduce the ankle and if soft tissues allow, a back slab is given.
If there is soft tissue injury, I will span the fracture with delta frame and order for a CT scan once the patient is stabilised.
This is a Ruedi and Algower type III fracture and I will plan for definitive fixation once the soft tissues are wrinkled as per the principles proposed by R and A
Ruedi and Algower principles
Fibula length and rotation restoration
Precise articular reconstruction
BG metaphyseal defects
Stabilse for early ROM exercises
Anterior approach for tibia and PL approach for fibula