Proximal tibial fractures: Classifications and biomechanical principles—an update

Abstract

Although newly developed computed tomography (CT)-based classifications for proximal tibial fractures could not exactly depict all fracture types, an individual treatment concept can be deduced from them. The use of these classifications enables a well-structured approach to stabilize most fracture patterns. In own studies it could be demonstrated how important it is to pay attention to coronal and sagittal fracture lines. Therefore, consistent use of reproducible three-dimensional CT-based classifications may lead to a standardized surgical treatment algorithm and may facilitate preoperative planning. Consequently, this may result in reduced operation times and improved clinical results. Unicondylar fractures can be successfully stabilized by the combination of screw and plate osteosynthesis, which in the case of impression fractures of the tibial plateau has to be supplemented by additional defect augmentation. Due to the complexity of bicondylar fractures there is a broad spectrum of options available for osteosynthesis. It is essential to make an accurate analysis of fracture morphology and the stable retention of essential fracture fragments, particularly the dorsal fragments.