Eur J Orthop Surg Traumatol. 2026 Aug 1;36(1):313. doi: 10.1007/s00590-026-04902-y.
ABSTRACT
PURPOSE: Spiral tibial shaft fractures (AO 42-A1) frequently present with distal intra-articular extension, particularly involving the posterior malleolus. The purpose of this study was to determine the frequency of distal intra-articular extension in AO 42-A1 fractures and to evaluate its impact on postoperative functional outcomes.
METHODS: A retrospective cohort study was conducted including 83 patients (age > 18 years) surgically treated for AO 42-A1 fractures between 2019 and 2024 at a high-complexity university hospital. All patients underwent preoperative ankle computed tomography (CT). Demographic, surgical, and functional variables were analyzed using the American Orthopaedic Foot and Ankle Society (AOFAS) score. Non-parametric tests and age-adjusted linear regression were applied.
RESULTS: Distal articular extension was identified in 60.2% of cases (50/83). The median AOFAS score was 90 (IQR 81.5-100) in the group with articular extension and 88 (IQR 78-100) in the group without extension (p = 0.50). Age was negatively associated with AOFAS scores (coefficient - 0.37; p = 0.001). The most frequent associated injury was posterior malleolar fracture (74%). Syndesmotic fixation was performed in 7.2% of cases and did not influence functional outcomes.
CONCLUSION: Distal articular extension is highly prevalent in spiral tibial shaft fractures but was not associated with worse postoperative functional outcomes when appropriate surgical management was performed. Patient age was the primary factor influencing functional results. Preoperative CT is essential for detecting occult articular injuries in this fracture pattern.
PMID:42542539 | DOI:10.1007/s00590-026-04902-y