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[The incidence, therapy and results of combined ankle joint and tibial shaft fractures].

Forty combined tibial shaft and ankle fractures were admitted to our Trauma Department between 1980 and 1985; these cases were followed up, and the results are presented. Using the classification scheme of Johner/Wruhs for lower-leg fractures and that of Lauge-Hansen for ankle fractures, we found 25 pronation-eversion and 14 supination-eversion lesions combined with pure spiral fractures (A1, 9 cases), spiral bending-type fractures (B1, 25 cases), comminuted spiral lesions (C1, 5 cases), and 1 crush fracture (C3). Although no fibular or ligamentous reconstruction had been done and various methods had been used, overall, the late results were good. In contrast to previous reports about this rare condition, no incongruencies at the ankle joint were found. Only 2 cases of late arthritis due to infection and/or improper reduction were seen. Nevertheless, the importance of thorough analysis of the fracture pathomechanics before treatment cannot be overemphasized. If anatomical reduction of the tibial shaft fracture does not imply congruency at the joint line, reconstruction of the fibular or ligamentous lesion should be undertaken.