Object: intra-articular fractures of the distal metaepiphysis of the shin bones. Aim: improve the anatomical and functional results of treatment of patients with fragmental intra-articular fractures of the distal leg bones by reducing additional impairment of blood supply to fragments during surgery, biomechanical substantiation of the stability of osteosynthesis and the differentiated use of improved technologies of minimally invasive osteosynthesis. Methods: clinical, radiological, morphological, mathematical modeling, computer reconstruction, biomechanical, statistical. On the basis of anatomical and X-ray-tomographic studies new knowledge about the location features of the nutrient foramens in the distal epimetaphyses surface through which the vessels enter the bone is obtained. It is shown for the first time that the nutrient foramens are unevenly distributed in the tibial epiphyses surface, and the largest number are located on the anterior-inner surface of the tibia epiphysis. Theoretical calculations using of the finite element models of "fragments – plate", "fragments – needls", "fragments – needls – external apparatus" proved that the stresses in the bone fragments, fixation devices and between them during movements in the ankle joint are comparable and can not lead to destruction and pathological displacement. Based on clinical studies, it has been established that the use of minimally invasive osteosynthesis in case of distal metaphyseal fractures of the lower leg bones (clinical groups I and II), according to the Ankle-Hind foot Scale, in the long term provide anatomical and functional results that are generally comparable to the results fixation of fragments by plates. The expediency of taking into account topographically-constitutional features of patients during the planning of surgery treatment of distal metaphyseal fractures of the lower leg bones is substantiated, which increases its efficiency, increasing the share of good results. Performed anatomical and theoretical studies help the practitioner to understand the level of additional traumatization of the sources of blood supply by connecting the fragments with plates in the case of complex fractures of the distal tibia, and brings up an anatomically critical approach to the choice of treatment method. An algorithm for the differentiated selection of pilon fracture osteosynthesis technologies according to the type and nature of the injury was developed and proposed, which allows to obtain good results in the postoperative period. As a result of clinical studies, it has been proven that the preservation of the blood supply sources of fragments that have preserved their integrity, and the restoration of the anatomical shape of the bones, should be attempted without additional openings during the treatment of distal metaphyseal fractures of the lower leg bones. The results of the study were introduced into the scientific and clinical work of the Higher State Educational Establishment of Ukraine "Bukovinian State Medical University", into the clinical practice of the Regional Communal Institution "Chernivtsi Regional Clinical Hospital", the Communal Non-profit Enterprise
