Investigating the effectiveness of anterolateral distal tibia plate in treating distal tibial fractures in adults: a prospective study


  • Mukul Jain Department of Orthopaedics, Jhalawar Medical College, Jhalawar, Rajasthan, India
  • Sukhveer Khichar Department of Orthopaedics, Jhalawar Medical College, Jhalawar, Rajasthan, India
  • Naveen Sathiyaseelan Department of Orthopaedics, Saveetha Medical College, Chennai, Tamil Nadu, India
  • Rajesh Jewliya Department of Orthopaedics, Jhalawar Medical College, Jhalawar, Rajasthan, India
  • Harish Kumar Jain Department of Orthopaedics, Jhalawar Medical College, Jhalawar, Rajasthan, India



Anterolateral distal tibia plate, Ovadia and Beals scoring system, Open reduction and internal fixation, Distal tibial fractures, Lower extremity trauma


Background: “Pilon” fractures of the distal tibia are a term used usually by orthopaedic surgeons. High-energy trauma and related soft tissue injuries are the main causes. It might be challenging to treat distal one-third of tibial fractures that affect the articular process or not. The objective of this work is to analyze the result of the Anterolateral Distal Tibia Plate in distal tibial fracture treatment in adults.

Methods: After receiving permission from the ethical committee, this prospective interventional analysis was conducted among 25 patients who satisfied the inclusion standards and were given anterolateral distal tibia plates. The scoring system created by “Ovadia and Beals” was used to evaluate patients at the conclusion of the follow-up period.

Results: The participants in this research varied in age from 18 to 64, with a mean age of 36. 13 patients had a left tibia fracture and 12 patients had a right tibia distal end fracture. There were 4 open GA-I fractures and 21 closed GA-I fractures. 18 patients got fractures as a result of road traffic accidents (“high energy trauma”), and 7 patients sustained a fracture due to a fall (low energy trauma). The union of fracture occurred in 24(96%) patients and 1(4%) case showed delayed union. The average period of union was 18 weeks with the radiological signs of callus formation. 2 patients developed superficial and 1 patient developed deep infection.

Conclusions: Distal end tibial fractures especially with intra-articular involvement may be effectively treated by anterolateral plating within a single stage, offers advantages such as adequate fracture exposure, soft tissue preservation, and reliable fracture healing.


Canale ST, Beaty JH. Campbell's Operative Orthopaedics. 11th ed. St. Louis: Elsevier Health Sciences; 2007:3;3117-8.

Court-Brown CM, Robert WB, James DH, Charles M, Paul T. Rockwood and Green's Fractures in Adults. Philadelphia, PA: Lippincott Williams and Wilkins; 2005.

Court-Brown CM, McBirnie J. The epidemiology of tibial fractures. J Bone Joint Surg Br. 1995;77:417-21.

Joshi D, Ahmed A, Krishna L, Lal Y. Unreamed interlocking nailing in open fractures of the tibia . J Orthop Surg. 2004;12:216-21.

Michelson J, Moskovitz P, Labropoulos P. The nomenclature for intra-articular vertical impact fractures of the tibial plafond: pilon versus pylon. Foot Ankle Int. 2004;25:149-50.

Mandi DM, Belin RP, Banks J, Barrett B. Pilon fractures. Clin Podiatr Med Surg. 2012;29:243-78.

Joveniaux P, Ohl X, Harisboure A. Distal tibia fractures: management and complications of 101 cases. Int Orthop. 2010;34:583-8.

Zelle BA, Bhandari M, Espiritu M, Koval KJ, Zlowodzki M. Treatment of distal tibia fractures without articular involvement: a systemic review of 1125 fractures. J Orthop. Trauma. 2006;20:76-9.

Mauffrey C, Vasario G, Battiston B, Lewis C, Beazley J, Seligson D. Tibial pilon fractures: A review of incidence, diagnosis, treatment, and complications. Acta Orthop Belg. 2011;77:432-40.

Ronga M, Longo UG, Maffulli N. Minimally Invasive locked plating of distal tibia fractures is safe and effective. Clin Orthop Relat Res. 2010;468:975-82.

Maffulli N, Toms AD, McMurtie A, Oliva F. Percutaneous plating of distal tibial fractures. Int Orthopaed. 2004;28:159-62.

Lau TW, Leung F, Chan CF, Chow SP: Wound complication of minimally invasive plate osteosynthesis in distal tibia fractures. Int Orthopaed. 2008;32:697-703.

Shrestha D, Acharya BM, Shrestha PM. Minimally invasive plate osteosynthesis with locking compression plate for distal diametaphyseal tibia fracture. Kathmandu Univ Med J. 2011;9:62-8.

Im GI, Tae SK. Distal metaphyseal fractures of the tibia: a prospective randomized trial of closed reduction and intramedullary nail versus open reduction and plate and screws fixation. J Trauma. 2005;59:1219-23.

Ovadia DN, Beals RK. Fractures of the tibial plafond. J Bone Joint Surg Am. 1986;68:543-51.

Paraschou S, Bekir H, Anastasopoulos H. Evaluation of interlocking intramedullary nailing in distal. JMSCR. 2019;7(12):682-5.

Collinge CA, Sanders RW. Percutaneous plating in the lower extremity . J Am Acad Orthop Surg. 2000;8:211-6.

Farouk O, Krettek C, Miclau T, Schandelmaier P, Guy P, Tscherne H. Minimally invasive plate osteosynthesis. JAMA. 1997;3:7-12.

Clifford RP, Beauchamp CG, Kellam JF. Plate fixation of open fractures of the tibia. J Bone Joint Surg Br. 1988;70:644-8.

Jensen JS, Hansen FW, Johansen J. Tibial shaft fractures. A comparison of conservative treatment and internal fixation with conventional plates or AO compression plates. Acta Orthop Scand. 1977;48:204-12.

Cesari B, Lortat-Jacob A, Dinh A, Katabi M, Decrette E, Benoit J. Fractures of the anterior rim of the distal part of the tibia, Apropos of a series of 38 cases. Rev Chir Orthop Reparatrice Appar Mot. 1996;82:417-427.

Zelle BA, Bhandari M, Espiritu M, Koval KJ, Zlowodski U: Treatment of distal tibia fractures without articular involvement: a systematic review of 1125 fractures. J Orthop Trauma. 2006;20:76-9.

Vallier HA, Cureton BA, Patterson BM. Randomized, prospective comparison of plate versus intramedullary nail fixation for distal tibia shaft fractures. J Orthop Trauma. 2011;25:736-41.

Strauss EJ, Schwarzkopf R, Kummer F, Egol KA. The current status of locked plating: The good, the bad, and the ugly. J Orthop Trauma. 2008;22:479-86.

Synthes LC. Anterolateral distal tibial plate and lcp low bend medial distal tibial plate. technique guide. Available at: Accessed on 20 November 2022.

Gupta RK, Rohilla RK, Sangwan K, Singh V, Walia S. Locking plate fixation in distal metaphyseal tibial fractures: Series of 79 patients. Int Orthop. 2010;34: 1285-90.

Shabbir G, Hussain S, Nasir ZA, Shafi K, Khan JA: Minimal invasive plate osteosynthesis of close fractures of the distal tibia. J Ayub Med Coll Abbottabad. 2011;23:121-4.

Devendra L, Sharma G, Khatri K, Kumar GNK, Sharma V. Minimally invasive osteosynthesis of distal tibial fractures using anterolateral locking plate: Evaluation of results and complications. Chin J Traumatol. 2010;23:1939-44.

Kumar D, Singh J, Kumar R, Kumar H, Raj M, Mittal A. Osteosynthesis of distal tibial fractures using Anterolateral distal tibia locking compression plate. J Bone Joint Dis. 2019;34:10-5.

Maisonneuve JG. Recherches sur la fracture du péroné. France: Loquin and Cie; 2010:13.






Original Research Articles