MODERN APPROACHES TO THE TREATMENT OF DISTAL THIRD TIBIAL FRACTURES: A LITERATURE REVIEW

Background. Fractures of the distal third of the tibia remain among the most challenging injuries in modern orthopedic trauma due to the unique anatomical and biomechanical characteristics of this region, limited blood supply, and a high risk of complications. Despite continuous advances in osteosynthesis techniques, selecting the optimal treatment strategy remains controversial.

Objective. To review current evidence on the diagnosis, classification, conservative and surgical management of distal third tibial fractures and to evaluate the prospects for implementing modern digital technologies in clinical practice.

Materials and Methods. A narrative review of contemporary national and international literature on the treat­ment of distal third tibial fractures was conducted. Systematic reviews, meta-analyses, randomized clinical trials, and other relevant studies evaluating intramedullary nailing, minimally invasive plate osteosynthesis (MIPO), external fix­ation, and modern preoperative planning technologies were analyzed.

Results. Conservative treatment remains appropriate only for carefully selected cases. Modern intramedullary nailing, particularly using the suprapatellar approach, reduces operative time and decreases the risk of malalignment. The MIPO technique preserves the blood supply to bone fragments, promotes faster fracture healing, and lowers the incidence of infectious complications. External fixation remains the treatment of choice for severe open fractures, polytrauma, and infection-related complications. Current evidence demonstrates no significant differences in long-term functional outcomes between intramedullary nailing and plate osteosynthesis, highlighting the importance of individualized treatment selection. Emerging technologies, including computed tomography, three-dimensional printing, patient-specific surgical guides, computer-assisted navigation, and augmented reality, represent promising tools for improving surgical accuracy and patient outcomes.

Conclusions. The management of distal third tibial fractures should be individualized according to fracture characteristics, soft-tissue condition, and patient-specific factors. The application of biological fixation principles, min­imally invasive techniques, and modern digital planning technologies can improve treatment outcomes while reduc­ing complication rates.