الفهرس 
Chapter 1: IntroductionOnly 14 pages are availabe for public view
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Abstract
Distal tibial fractures can be treated by different methods of treatment. These fractures in which closed treatment is inappropriate can be treated with plate and screw, interlocking nail or Ilizarov. The choice of the treatment is depend on the type, site and the degree of comminution and according to the choice of the surgeon.
The distal end of the tibia was compressed and sheared posteriorly throughout most of stance. Internal muscle forces were the primary source of tibial compression, whereas the joint reflex force was the primary source of tibial shear due to the forward inclination of the leg relative to the external ground reaction force.
Assessment of patient with fractures of the distal tibia should be carried out in a systematic fashion including:
• History &Examination.
• Radiographic evaluation& CT&MRI.
Distal tibial fractures can be classified according to:
1) Soft tissue injury classification.
• Gustilo and Anderson & Tscherne and Gotzen classification.
2) Bony injury classification.
• The Ruedi and Allgower &AO Classification.
Indications for non operative treatment of fractures shaft tibia include low-energy fractures with:
(1) Minimal soft-tissue injury (types 0 and 1 according to the system of Tscherne and Gotzen).
(2) A stable fracture pattern, as defined by coronal angulation of 5°, sagittal angulation of <10°, rotation of <5°, and shortening of <1 cm.
(3) The ability to bear weight in a cast or functional brace.
Conversely, the Indications for operative treatment of tibial shaft fractures include:
(1) A high-energy fracture.
(2) Moderate to severe soft-tissue injury.
(3) An unstable fracture pattern, as defined by coronal angulation of 5°, sagittal angulation of 10°, rotation of 5°, and shortening of 1 cm.
(4) An open fracture.
(5) Compartment syndrome.
(6) An ipsilateral femoral fracture.
(7) An inability to maintain reduction.
(8) An intact fibula (a relative indication).
The fixation options for distal tibial fractures include hybrid external fixation, traditional open reduction internal fixation (ORIF), locking compression distal tibial plate, minimally invasive plate osteosynthesis (MIPO), or possibly intramedullary nailing.
Management of distal tibia fractures, with or without articular involvement, is a therapeutic challeng. And the results are not always excellent as the complication may occur such as:
• Compartmental syndrome& Neurovascular complication.
• Mal-union &Non union mal alignment or broken hard ware.
• Deep veins thrombosis & pulmonary embolism.
• Wound complications and Infection.
from October (2010) to November (2011) twenty cases of extra articular distal tibial fractures (thirteen males and seven females) were treated by using the locking compression distal tibial plate. There were 12 right and 8 left sided fractures distal tibia. And fracture type A1 = 11, A2 =2 and A3 =7.