The treatment of high energy fractures of distal tibia by internal fixation is followed by a high rate of soft tissue complications.

The result estimation of these fractures in a two stage treatment, bridging the ankle by Ex-Fix with/without internal fixation of the fibula and internal fixation of the tibia after soft tissue recovery

In a 4 year period (2005–8), 15 patients, average of 42 years were treated. The AO fracture classification was followed. The soft tissue damage estimation (Osternn-Tscherne and Gustillo classification), the fracture pattern of the fibula and the injury mechanism consisted of the choice method criteria. The majority of the injuries was classified Tscherne II & III, and 3 open fractures Gustillo II. Fracture reduction was performed by bridging Ex-Fix of the ankle with/without plating the fibula with a 1/3 or DCP 3.5 mm plate. Definite internal fixation of the tibia by locking plate was performed from 8th –14th postoperative day after soft tissue recovery. Preoperatively CT scan was performed with grate significance, defining the soft tissue condition, the surgical approach and the osteosynthesis type.

Follow up average 14 months. None of the patients developed infection. All wounds were healed in one stage. Superficial skin necrosis was conservatively treated in two patients.

Soft tissue complications, after internal fixation of high energy fractures of the distal tibial, usually appear. Two stages treatment allows better preoperative planning, immediate patient mobilization and reduce complication rate