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After a previous series [1] established good results for the reconstruction of normal anatomy with stable fixation for intraarticular fractures of the lower end of the tibia by one surgeon in a more rural setting, the authors examined a series of patients treated at a university hospital by residents. Results were positive, with good or excellent outcomes in 70% of patients, but not as good as the previous series. Several factors may be taken into account for this disparity in results: patients were older by a mean 10 years, injuries were due to road or working accidents rather than principally skiing injuries, and the quality of surgery/capability of the surgeon may be a factor as well. However, by following the four sequential principles listed below, results of these difficult fractures can still be rewarding.

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