The AO/OTA classification is one of the most frequently used systems for classifying distal tibial fractures or tibial distal end segment fractures. Like other fractures, they are divided into three groups subject to the severity and complexity of the respective injury 1, 2:
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type A: extraarticular distal tibial end segment fracture
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A1: simple extraarticular distal tibial fracture
A1.1 spiral fracture
A1.2 oblique fracture
A1.3 transverse fracture
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A2: distal tibial extraarticular wedge fracture
A2.1 posterolateral impaction fracture
A2.2 anteromedial wedge fracture
A2.3 diaphysial fracture extension
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A3: multifragmentary extraarticular fracture of the distal tibia
A3.1 three intermediate fragments
A3.2 more than three intermediate fragments
A3.3 diaphysial fracture extension
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type B: partial articular distal tibial end segment fracture
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B1: pure split fracture
B1.1 coronal oriented split fracture: anterior/isolated posterior Volkmann
B1.2 sagittal oriented split fracture: lateral/medial articular surface or the medial malleolus
B1.3 fragmentary metaphyseal split fracture
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B2: split depression fracture
B2.1 coronal oriented split depression fracture: anterior/posterior Volkmann
B2.2 sagittal oriented split depression fracture: lateral/medial articular surface
B2.3 sagittal oriented split depression fracture with a central fragment
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B3: partial articular depression fracture
B3.1 coronal oriented depression fracture: anterior/posterior Volkmann
B3.2 sagittal oriented depression fracture: lateral/medial articular surface
B3.3 fragmentary metaphyseal depression fracture
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type C: complete articular distal tibial end segment fracture
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C1: simple articular and metaphyseal fracture
C1.1 simple articular and metaphyseal without impaction: coronal or sagittal
C1.2 simple articular and metaphyseal with epiphyseal impaction
C1.3 diaphysial fracture extension
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C2: simple articular and multifragmentary metaphyseal fracture
C2.1 asymmetric impaction: coronal or sagittal
C2.2 without asymmetric impaction
C2.3 diaphysial fracture extension
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C3: multifragmentary articular and metaphyseal fracture
C3.1 multifragmentary epiphyseal fracture
C3.2 multifragmentary epiphyseal and metaphyseal fracture
C3.3 multifragmentary epiphyseal, metaphyseal and diaphysial fracture
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Isolated medial malleolar fractures and isolated posterior malleolar or Volkmann fractures are classified as partial articular distal tibial end segment fractures as long as there is no fibular fracture. If they are associated with a lateral ankle injury or a fibular fracture they are coded as a malleolar segment fracture 1.