Management Of Proximal Tibia Fractures Research Articles

What’s New and Relevant in Proximal Tibia Fractures?

Proximal tibia fractures include fractures of the tibia plateau and metaphyses and are relatively common injuries. The goals of treatment follow AO principles of anatomic reduction of the articular surface, restoration of limb alignment, length, and rotation. Despite notable advancements in implant design, management of proximal tibia fractures remains formidable. These fractures manifest as comminuted, intra-articular complexities, compounded by the inherent fragility of the osteoporotic bone, thereby rendering fixation a particularly intricate risk. In the realm of geriatric trauma, where comorbidities abound, therapeutic decision-making becomes a nuanced endeavor. We have aimed to bring together all the recent advances and literature in the management of proximal tibia fractures through this article. Keywords: Proximal tibia, Plating, Nailing, Prosthesis.

Epidemiology and management of proximal tibia fractures in children and adolescents: a population-based study based on the Kids' Fracture Tool.

Proximal tibial fractures are infrequent injuries in children, and the literature on epidemiology, associated injuries, and management is limited. We calculated a population-based incidence and described the characteristics of proximal tibial fractures in children in terms of complications and management. This is a retrospective study over a 6-year-period during including 241 children with proximal tibial fractures who presented to our university hospital. Demographic and fracture-related data was collected from the Kids' Fracture Tool. The number of children during the study period was collected from statistical yearbooks of the City of Helsinki to estimate annual incidence. Extra-articular fractures (129/241) peaked at the age of 3 and tibial tubercle (42/241) and intra-articular fractures (70/241) peaked at the age of 15. Annual incidences were estimated to be 3.4/100,000 children and 22/100,000 children in the age group of 13-16 years for ACL avulsions, and 3.8/100,000 children and 21/100,000 children in the age group of 13-16 years for tibial tubercle fractures. The incidence of vascular compromise (0%) and compartment syndrome was low (0.4 %, 1/241). Proximal tibial fractures present with a bimodal distribution, with extra-articular fractures peaking at the age of 3 years and fractures of the tibial tuberosity and intra-articular fractures peaking at the age of 15 years. Additionally, associated compartment syndrome and vascular compromise was not as common as previously reported.

Hybrid external fixator as primary fixation in the management of proximal tibia fractures in low resource setting –our experience

Tibial plateau fractures consists of 1% of all fractures. The goals in management of such fractures are anatomical reduction and maintaining joint congruity,stable fixation of fracture fragments, restoration of joint alignment with minimal soft tissue dissection and early mobilization.The purpose of the study is to highlight the technique and assess the utility and functional outcome of hybrid external fixation in periarticular fractures of tibia.A prospective study to determine the functional and radiological outcome of hybrid external fixation in management of periarticular fractures of proximal tibia which included both open (Gustilo Anderson IIIA &B) and closed injuries(Shatzker 5 &6) at our institution. 81 patients with 36 months follow up showed excelled and good outcome in 88% with Rasmussen’s knee score using hybrid external fixator as primary modality of treatment with less than 20% of cases requiring additional procedures and all cases united and there was no case of non union.The hybrid external fixator provides proper osseous stability without compromising the soft tissue and allows early mobilization which results in good functional outcome.

Functional outcome of proximal tibia fracture treated with bicondylar plating by dual approach-lobenhoffer and lateral approach

Background: Proximal tibia fractures necessitates early diagnosis and management to prevent severe complications. The goal of treating proximal tibia fractures is to achieve anatomical reduction of articular surface and bring back the functional mobility to pre injury status. Lobenhoffer approach provides direct visualization of fracture, better reduction technique which helps to achieve anatomical reduction and alignment. Aim: To assess the reduction of proximal tibia fractures, radiological union and functional outcome associated with treatment by dual approach. Objectives 1. To assess the anatomical reduction of proximal tibia articular surface in fractures treated with internal fixation. 2. Assessment of radiological union of fractures after internal fixation by dual plating. 3. Assessment of clinical outcome associated with this approach. Materials and Methods: A total of 30 cases of bicondylar proximal tibia fractures were studied. Inclusion criteria 1. All skeletally mature patients with proximal tibia fractures Schatzker type V and VI aged between 18 and 65 years. 2. AO Muller type 41-C1,41-C2,41-C3.Exclusion criteria 1. Unicondylar tibial fractures. 2. Skeletally immature patients 3. Pathological proximal tibia fractures. Observation and Results: Our study used Honkonen and Jarvinen criteria for functional outcomes and showed good results. Conclusion: Early surgical management of proximal tibia fractures is necessary as tibial plateau can tolerate modest deformities. Lobenhoffer and lateral approach provides better visualization of fracture and aids in better surgical management of bicondylar proximal tibial fractures with dual plating and gives excellent anatomical reduction, maintenance of mechanical axis and hence a better functional outcome with effective rehabilitation.

Comparison between standard radiography and spiral CT with 3D reconstruction in the evaluation, classification and management of tibial plateau fractures

Background: Proximal tibia is one of the most critical weights bearing part of the human body. Fractures of the plateau affect knee alignment, stability, and motion. The present study was conducted to decide whether pre-operative CT scan significantly changes the line of action and plan of surgery, against simple digital radiographs, in managing fractures of the upper tibial condyles and hence should it be an essential investigation for treatment in proximal tibial fractures.Materials & Methods: The present cross-sectional, prospective study was conducted on 42 cases (males- 37, females-5) of traumatic fractures of the proximal tibia. First opinion was taken on the basis of the X-ray alone and second opinion was taken after showing the CT scans.Results: There were 16 (38.09%) patients in age group of < / = 30 years, 17 (40.48%) patients in age group of 30-45 years, 8 (19.05%) patients in age group of 45-60 years and only 1 (2.38%) patient is the age group of 60-75 years. There were 02 (04.76%) patients diagnosed to have no fracture based on X-ray, 14 (33.33%) patients diagnosed as Schatzker’s type-1, 02 (04.76%) patients diagnosed as Schatzker’s type-2, 05 (11.91%) patients diagnosed as Schatzker’s type-4, 13 (30.95%) patients diagnosed as Schatzker’s type-5 and 06 (14.29%) patients diagnosed as Schatzker’s type-6 based on X-ray alone. A total 12 cases were included in Schatzker’s type 1. Management of 01 case was drastically changed, that of 03 cases had subtle changes and that of 08 cases remained unchanged. Plan of 01 case out of 04 included in Schatzker’s type 2 was changed drastically, 02 underwent subtle changes while that of 01 was unchanged. Only 01 case was included in Schatzker’s type 3. Its management underwent subtle change. 02 cases were diagnosed as type 4. Treatment of 01 underwent subtle change while that of 01 remained unchanged. Plan of 02 cases out of 06 included in type 6 were drastically changed. 04 had no changes.Conclusion: CT scan contributes significantly in management of proximal tibia fractures especially in Schatzker’s type 1 and type 4. It reveals articular depressions and fracture fragments that are often obscured on X-rays. It helps surgeons to prevent dreadful postoperative complications.

Functional outcome of locking compression plate in the management of proximal tibia fracture

Background: The proximal tibia fractures are one of the commonest intra-articular fractures. These injuries fall into two broad categories, high energy fractures and low energy fractures. The majority of tibial plateau fractures are secondary to high velocity accidents and fall from height where fractures result from direct axial compression, usually with a valgus (more common) or varus movement and indirect shear forces. Proximal tibial fractures present a spectrum of soft tissue and bony injuries that can produce permanent disabilities.Objective: This study evaluates the effectiveness of LCP (locking compression plate) in the management of proximal tibia fractures based on clinio-radiological assessment.Methods: It is a prospective observational study with sample size of 30 and all patients having intraarticular and or juxtaarticular fracture of proximal part of tibia, using AO classification system. Post operatively patients were followed up after 2 weeks, 6 weeks and at 3 month then monthly till union.Results: Fair to good functional results were correlated with associated injury whereas excellent results were obtained with those who did not sustained other associated injury.Conclusion: locking compression plate offers a good treatment option for intraarticular and juxtaarticular fractures of proximal part of tibia without the need for additional medial stabilization.Level of evidence: prospective level III follow up study.

To study surgical management of proximal tibia fractures by locking compression plate

Proximal Tibial fractures have been studied and reported extensively and exhaustively but still controversy exists over its management, whether surgical or conservative. Excellent results have been published in both groups. On one hand, we have got a group of surgeons who says that most of the Proximal Tibial fractures can be managed by conservative treatment and on the other hand, other group says conservative treatment means therapeutic nihilism and except for undisplaced fracture every Proximal Tibial fracture should be operated upon to achieve anatomical reduction and rigid internal fixation. Even undisplaced Proximal Tibial fractures should be operated, so that early mobilization of knee it is possible4. The objectives of treatment of Proximal Tibial fracture, is precise reconstruction of the articular surfaces, stable fragment fixation allowing early mobilization and repair of all concomitant ligamentous and other soft Tissue lesions.

Functional outcome of proximal tibial fracture treated surgically using locking compression plate

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Tibial plateau fractures are common intra-articular fractures, representing 1.2% of all fractures. These fractures are common in two age groups: as higher-energy fractures in younger patients and lower-energy fractures in elderly patients secondary to osteopenia. In the younger population, these injuries are associated with an increased incidence of complications like nonunion, infection, restriction of motion, and post-traumatic arthritis. The study aimed for final outcome of proximal tibial fracture using locking compression plate by minimally invasive percutaneous plate osteosynthesis (MIPPO).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 30 cases of proximal tibial fractures were treated by using locking compression plate and studied from December 2015 to November 2017 in Department of Orthopaedics, Dr. S.N. Medical College associated group of Hospitals, Jodhpur.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; All the selected 30 cases were followed up for 6 months. The average time for union of fracture was 21 weeks ranging from 18-24 weeks. Full weight bearing was not allowed until 12 weeks or complete fracture union. Partial immobilization was kept for 6 weeks in long knee brace. An average flexion was achieved upto0-114&lt;sup&gt;0&lt;/sup&gt;. We observed 4 cases of postoperative complications that included 2 infections, one knee stiffness and one varus deformity.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Surgical management of proximal tibia fractures with only lateral plating by MIPPO gave excellent reduction, rigid fixation to restore articular congruity and provides early motion to achieve optimal knee function and reducing post-traumatic osteoarthritis.&lt;/p&gt;

Short term outcome analysis of proximal tibia fractures treated with minimally invasive plate osteosynthesis

Introduction: Proximal tibial fractures caused by high-energy mechanisms are associated with neurovascular injuries, compartment syndrome, deep vein thrombosis, contusion, crush injury to the soft tissues and open wounds. Management of proximal tibia fractures are difficult considering the limited soft tissue cover over the shin of tibia and vascular compromise following injury. Open reduction and internal fixation in oedematous vascular compromised skin will end up in complications like infection and wound dehiscence. Management of proximal tibia fractures using minimally invasive plate osteosynthesis reduces damage to surrounding soft tissues and helps in improved fracture healing without complications. Analysis of functional and radiological outcome along with the complications of proximal tibial fractures treated by minimally invasive plate osteosynthesis using Knee Society Score. Materials & Methods: We have analysed 20 cases of proximal tibial fractures treated surgically using minimally invasive plate osteosynthesis admitted in our Institute between January 2016 and December 2017. All patients were preoperatively assessed radiologically and classified and managed by MIPO technique and outcome was analysed by Knee Society score. Results: Majority of injured patients were male (90%) and the highest number of patients were in their 4th decade (60%). Road traffic accidents was the most common mode of injury (80%). Type VI fracture is the most common type in 60% patients. Early complications like wound gaping, skin necrosis were treated. Average time from injury to surgery was 10 days. All of our patient’s results were excellent and good. The average knee society score in our study with 20 patients was 81. All fractures united after an average of 20 weeks. The mean time to full, unprotected weight bearing was 16 weeks. Conclusion: Proximal Tibial fractures treated surgically using minimally invasive plate osteosynthesis technique gives early functional ability and early mobilisation of knee joint. Minimally invasive plate osteosynthesis technique offers improved fracture healing without any risk of soft tissue complications when compared to conventional plating by open reduction and internal fixation.

Less invasive stabilization system for the management of proximal tibia fractures

Proximal tibia fractures are difficult to treat especially when soft tissues are compromised by conventional open reduction and internal fixation with high complication rates. Many methods have been tried to manage these fractures. Less invasive stabilization system (LISS) is the latest technology applied for these injuries. This report presents clinical results of the LISS for the treatment of complex proximal tibia fractures. From June 2007 to May 2010, total of 35 cases of the proximal tibia fractures (19 AO type 41A, 11 type 41B and five AO type 41C) were treated with the LISS technique. Clinical and radiological evaluation was done at 6, 10, 14, 20, 24 weeks and 9, 12, 18 and 24 months, respectively. The mean age of the patients was 50.17 years (range 20-73 years); male patients were 21 and female 14. The mean follow-up time was 31.42 months (range 21-42 months). The patients were evaluated using Knee Society scores, and the mean score was 92.11 (range 84-100); the mean full weight bearing time was 15.8 weeks (range 12-22), and union time was 25.17 weeks (range 20-29). Superficial infections and slight mal-alignment were seen on five patients each. The less invasive stabilization internal fixator system can be used successfully to treat complex proximal tibia fractures with minimal complications. It can be an alternative method for the treatment of the proximal tibia fractures.