Management of Proximal Tibial Fractures
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 a
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Introduction The proximal tibia has been defined as the part of the tibia that extends from the knee joint distally for 1.5 times the medial to lateral joint width [53] (Fig. 1). Fractures that occur in this area are grossly heterogeneous and their prognosis depends on several factors. The most important are: (a) intra-articular involvement and severity (such as the degree of articular step-off and the extent and separation of condylar fracture lines), (b) the degree of fracture comminution and extension, (c) the condition of the soft-tissue envelope, (d) osteoporosis and (e) patient’s age and co-morbidities [82]. While all these factors should be considered whenever surgeons are dealing with fractures of the proximal tibia, fractures of the tibial plateau are an entity on their own and their management is completely differentiated from meta-diaphyseal fractures that do not extend into the knee joint. Therefore, the current review will be separated in two main parts, the current treatment options for extra-articular proximal tibial fractures followed by the current management of C. Garnavos, MD, PhD Department of Orthopaedic, Evangelismos General Hospital, 45-47 Ipsilandou St, 10676 Athens, Greece e-mail: [email protected]
tibial plateau fractures. However, the injury of the soft tissues that surround the proximal tibia is a problem common to both extra- and intra-articular fractures and should be considered seriously prior to fracture treatment.
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Fig. 1 Drawing that defines the Proximal Tibia (Lindvall et al. [53])
G. Bentley (ed.), European Instructional Lectures, European Instructional Lectures 13, DOI 10.1007/978-3-642-36149-4_8, © EFORT 2013
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Fig. 2 Schatzker classification of intra-articular (tibial plateau) fractures. The fractures are classified from grades (I–VI) according to the severity and complexity of the bony injury
Epidemiology
Classification
Intra-articular proximal tibial fractures account approximately for 1 % of all fractures in the general population and about 8 % of fractures in the elderly and affect males more commonly than females [60]. The causes are road traffic accidents in 52 % of cases, falls in 17 % of cases and sporting or recreational activities in 5 % of cases [16, 60]. The lateral plateau alone is affected from 55 to 70 % of tibial plateau fractures, 10–25 % involve only the medial plateau and 10–30 % are bi-condylar fractures [60]. Approximately, 90 % of all tibial plateau fractures have some sort of soft tissue injury and 1–3 % are open fractures [21]. Extra-articular proximal tibial fractures are estimated to be 5–10 % of all tibial fractures [51].
Intra-articular proximal tibial fractures are mostly classified with the classifications introduced by Schatzker et al. [72] (Fig. 2) and AO/OTA compendium [58, 72] that also classifies extra-articular proximal tibial fractures (Fig. 3). Extra-articular fractures can be also classified with a simpler classification that we introduced recently (Garnavos classification) and can b
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