Release notes for proximal tibia fractures

The content was authored by David Barei (US). Michael Baumgaertner (US) was the editor. J. Spence Reid (US) was the author of the ring fixator content. Markku Nousiainen (CA) and Andrew Oppy (AU) were the authors of the intramedullary nailing content.

The third edition of the proximal tibia module includes a detailed description of the following fracture types and their management.

Avulsion fracture of the fibular head:

• Nonoperative treatment
• Suture and screw fixation

Avulsion fracture of the tibial tubercle:

• Nonoperative treatment
• ORIF - Conventional plating
• Lag screw fixation

Avulsion fracture of the tibial spine:

• Nonoperative treatment
• Lag screw fixation
• Suture fixation

Avulsion of the posterior cruciate ligament:

• Nonoperative treatment
• Posterior cruciate ligament avulsion fixation

Simple extraarticular fracture:

• Nonoperative treatment
• Bridging external fixation (temporary)
• Ring external fixation (definitive)
• Angular stable plating
• ORIF - Conventional plating
• Intramedullary nailing

Wedge or multifragmentary extraarticular fracture:

• Nonoperative treatment
• Bridging external fixation (temporary)
• Ring external fixation (definitive)
• Angular stable plating
• ORIF - Conventional plating
• Intramedullary nailing

Lateral plateau split fracture:

• Nonoperative treatment
• Bridging external fixation (temporary)
• ORIF - Lag screw fixation
• ORIF - Conventional plating

Medial plateau split fracture:

• Nonoperative treatment
• Bridging external fixation (temporary)
• ORIF - Conventional plating

Depression fracture:

• Nonoperative treatment
• Bridging external fixation (temporary)
• ORIF - Conventional plating

Lateral plateau split-depression fracture:

• Nonoperative treatment
• Bridging external fixation (temporary)
• ORIF - Conventional plating

Medial plateau split-depression fracture:

• Nonoperative treatment
• Bridging external fixation (temporary)
• ORIF - Conventional plating

Complete simple articular fracture with simple metaphyseal components:

• Nonoperative treatment
• Bridging external fixation (temporary)
• Ring external fixation (definitive)
• Angular stable plating
• ORIF - Conventional plating
• Intramedullary nailing

Complete simple articular fracture with fragmentary metaphyseal components:

• Nonoperative treatment
• Bridging external fixation (temporary)
• Ring external fixation (definitive)
• Angular stable plating
• ORIF - Conventional plating
• Intramedullary nailing

Complete articular fracture with fragmentary lateral plateau:

• Nonoperative treatment
• Bridging external fixation (temporary)
• Ring external fixation (definitive)
• ORIF - Conventional plating
• Angular stable plating

Complete articular fracture with fragmentary medial plateau:

• Nonoperative treatment
• Bridging external fixation (temporary)
• Ring external fixation (definitive)
• ORIF - Conventional plating
• Angular stable plating

The following additional material is available for this module.

Approaches:

• Anterolateral and extended anterolateral approach to the proximal tibia
• Approach for minimally invasive osteosynthesis (MIO) of the proximal tibia
• Arthroscopic approach to the knee
• Medial and posteromedial approach to the proximal tibia
• Prone posteromedial approach to the proximal tibia
• Safe zones in the tibia for wire and Schanz screw insertion
• Semi-extended suprapatellar approach for intramedullary nailing of the tibia
• Straight lateral approach

Patient preparations:

• Prone position
• Semi-extended knee position for intramedullary nailing
• Supine position
• Supine position for ring fixation

Further reading:

• Intraoperative imaging of the proximal tibia
• Operative vs nonoperative treatment
• References

The content was authored by Matthias Hansen (DE) and Rodrigo Pesantez (CO). Ernst Raaymakers (NL) and Joseph Schatzker (CN) were the editors.

The second edition of the proximal tibia module includes a detailed description of the following fracture types and their management.

Extraarticular fracture, avulsion of fibular head:

• Nonoperative treatment
• Tension band fixation
• Lag screws
• Suture anchors

Extraarticular fracture, avulsion of tibial tubercle:

• Nonoperative treatment
• Lag screws

Extraarticular fracture, avulsion of tibial spine or capsular attachments:

• Nonoperative treatment
• Lag screws (tibial spine)
• Wire fixation (tibial spine)
• Suture anchors (capsular attachment)

Extraarticular fracture, metaphyseal simple:

• Nonoperative treatment
• Bridging external fixator (temporary)
• Non-bridging external fixator (definitive)
• Ring external fixator (definitive)
• MIO – Angular stable plate (LISS)
• ORIF – Plates without angular stability

Extraarticular fracture, metaphyseal wedge or multifragmentary:

• Nonoperative treatment
• Bridging external fixator (temporary)
• Non-bridging external fixator (definitive)
• Ring external fixator (definitive)
• MIO – Angular stable plate (LISS)
• ORIF – Plates without angular stability

Partial articular fracture, split:

• Nonoperative treatment
• Bridging external fixator (temporary)
• Ring external fixator (definitive)
• MIO - Percutaneous lag screws
• ORIF - Lag screws
• ORIF - Plates without angular stability

Partial articular fracture, depression:

• Nonoperative treatment
• Bridging external fixator (temporary)
• Ring external fixator (definitive)
• ORIF - Plates without angular stability

Partial articular fracture, split-depression:

• Nonoperative treatment
• Bridging external fixator (temporary)
• Ring external fixator (definitive)
• ORIF - Plates without angular stability

Complete articular fracture, simple articular, simple metaphyseal:

• Nonoperative treatment
• Bridging external fixator (temporary)
• Ring external fixator (definitive)
• MIO - Angular stable plate (LISS)
• ORIF – Plates without angular stability

Complete articular fracture, simple articular, multifragmentary metaphyseal:

• Nonoperative treatment
• Bridging external fixator (temporary)
• Ring external fixator (definitive)
• MIO - Angular stable plate (LISS)
• ORIF – Conventional plates

Complete articular fracture, fragmentary articular:

• Nonoperative treatment
• Bridging external fixator (temporary)
• Ring external fixator (definitive)
• ORIF - Conventional plates
• ORIF – Angular stable plate (LISS)

The following additional material is available for this module.

Approaches:

• Anterolateral approach to the proximal tibia
• Medial/posteromedial approach to the proximal tibia
• Posterior approach to the proximal tibia
• Approach for minimally invasive osteosynthesis (MIO) of the proximal tibia
• Safe zones in the tibia for pin placement
• Arthroscopic approach to the knee

Preparations:

• Supine position
• Floating position
• Lateral position
• Prone position

Basic techniques:

• Lag screw technique

Further reading:

• Intraoperative imaging of the proximal tibia
• Operative vs nonoperative
• References