![]() It is considered that the performance of this fixation together with the external fixator in the first stage does not increase soft tissue complications and facilitates joint reduction of the tibia. It is believed that fibula should be fixed with an external fixator in the first stage in distal tibiofibular fractures accompanying soft tissue injury. In addition, in case of comminuted fibula fracture or a bone defect, non-anatomical fibula fixation performed at the first stage may prevent anatomical tibia reduction during the permanent surgery 12. On the other hand, unplanned skin incision performed for fibula fixation at the first stage could pose a risk for the skin in the following step 11, 12. This may facilitate joint reduction and axial plan reduction in a permanent treatment 13. Moreover, it indirectly provides reduction of Volkmann and Chaput fragments via ligamentotaxis 12. Reduction of fibula with external fixation may lead to decrease in the lateral column of the tibia at the first stage. It is controversial to determine the stage when the fibula should be fixed 11, 12. In two-stage surgery, osteosynthesis of fibula fracture with plate is recommended for the preservation of tibial length and prevention of valgus malunion and rotation forces 2, 9, 10. Therefore, surgeons mostly prefer two-stage surgical protocol designed to support healing of traumatised soft tissue before the definitive fixation8. ![]() The most important factors associated with diminished wound complications are the recognition of soft tissue injury, appropriate surgical timing, and the application of a surgical procedure considering soft tissue healing. The most appropriate treatment modality for IDTF fracture is controversial since there is not a single universally accepted method 6, 7. The aim of the therapy in intra-articular distal tibiofibular (IDTF) fractures include restoring the joint and ankle functions, ensuring appropriate fracture union, anatomically reducing all fracture fragments, and managing soft tissues 4, 5. Closed tibia fractures may often accompany intensive contusions, fracture bullae, or severe muscle injury 3. Having experienced after high-energy injuries, these fractures were commonly complicated with soft tissue injury, which may result from the destructive impact of the fracture transmitted to soft tissues. 9, 2020.Distal tibia fractures constituted 7 to 10% of all tibia fractures and up to 80% of them were reported to be associated with ipsilateral fibula fractures 1, 2. American Academy of Orthopaedic Surgeons. National Institutes of Health Osteoporosis and Related Bone Diseases National Resource Center. American Orthopaedic Foot & Ankle Society. In: Pfenninger and Fowler's Procedures for Primary Care. Studies also show that healing after a fracture may take longer in people who smoke. ![]() Cigarette smoking can increase your risk of developing osteoporosis. Having decreased bone density (osteoporosis) can put you at risk of injuries to your ankle bones. Walking around in a house with too much clutter or too little light may lead to falls and ankle injuries. Keep your home cluttered or poorly lit.Whether you're a trained athlete or someone who's just started exercising, suddenly boosting the frequency or duration of your exercise sessions can increase your risk of a stress fracture. Suddenly increase your activity level.Improper training techniques, such as not warming up and stretching, also can cause ankle injuries. Faulty equipment, such as shoes that are too worn or not properly fitted, can contribute to stress fractures and falls. Use improper technique or sports equipment.The stresses, direct blows and twisting injuries that occur in sports such as basketball, football, gymnastics, tennis and soccer can cause ankle fractures. You may be at higher risk of a broken ankle if you:
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