Management of Proximal Tibial Fractures

Abstract

Proximal tibial fractures constitute a grossly heterogeneous group of bony injuries. Inevitably, their management varies and depends mainly on the fracture pattern and the condition of the surrounding soft tissues. Although conservative treatment can be attempted in simple, undisplaced fractures (without or with minimal intra-articular involvement), the management of most proximal tibial fractures should be operative, as apart from the necessity for anatomical reduction, surgical treatment will allow immediate knee motion and early weight-bearing and return to pre-injury activities. Minimally-invasive plate osteosynthesis (MIPO) with new locking plates alongside with modern hybrid external fixation devices are mostly used nowadays for the management of intra-and extra-articular fractures of the proximal tibia. However, latest modifications and improvements of intramedullary nailing techniques have contributed to its establishment as reliable treatment option for the management of extra-articular proximal tibial fractures. Furthermore, the supplementary use of compression bolts has enabled us to exploit the advantages of intramedullary nailing in the treatment of bi-condylar fractures, a proposal that could change the therapeutic protocols regarding the management of complex intra-articular fractures of the proximal tibia in the future.