AO/OTA classification of distal tibial fractures

Last revised by Pir Abdul Ahad Aziz Qureshi on 5 Sep 2021

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:

  • type A: extraarticular distal tibial end segment fracture
    • A1: simple extraarticular distal tibial fracture
      • A1.1 spiral fracture
      • A1.2 oblique fracture
      • A1.3 transverse fracture
    • A2: distal tibial extraarticular wedge fracture
      • A2.1 posterolateral impaction fracture
      • A2.2 anteromedial wedge fracture
      • A2.3 diaphysial fracture extension 
    • 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
  • type B: partial articular distal tibial end segment fracture
    • 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
    • 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
    • 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
  • type C: complete articular distal tibial end segment fracture
    • 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
    • C2: simple articular and multifragmentary metaphyseal fracture
      • C2.1 asymmetric impaction: coronal or sagittal
      • C2.2 without asymmetric impaction
      • C2.3 diaphysial fracture extension
    • 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

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.

See also

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