Release notes of Pediatric proximal tibia

The content has been authored by Philip Henman (UK), Mamoun Kremli (SA), and Dorien Schneidmüller (DE) with Fergal Monsell (UK) as editor.

The pediatric material of the proximal tibia, first edition, includes a detailed description of the following fracture types and their management.

Epiphysiolysis (Salter-Harris I):

• Preliminary treatment - Splinting
• Nonoperative treatment - Casting
• Closed reduction - Casting
• Closed reduction - K-wire fixation
• External fixation for temporary stabilization
• Open reduction - K-wire fixation

Epiphysiolysis with metaphyseal wedge (Salter-Harris II):

• Preliminary treatment - Splinting
• Nonoperative treatment - Casting
• Closed reduction - Casting
• Closed reduction - K-wire fixation
• Closed reduction - Screw fixation
• External fixation for temporary stabilization
• Open reduction - K-wire fixation
• Open reduction - Screw fixation
• Open reduction - Plate fixation

Epiphyseal and epi-metaphyseal fracture (Salter-Harris III and IV):

• Preliminary treatment - Splinting
• Nonoperative treatment - Casting
• External fixation for temporary stabilization
• Open reduction - K-wire fixation
• Open reduction - Screw fixation
• Open reduction - Plate fixation

Avulsion of the tibial spine:

• Preliminary treatment - Splinting
• Nonoperative treatment - Casting
• Open reduction with arthrotomy - Screw fixation
• Arthroscopic assisted reduction - Screw fixation
• Suture fixation

Avulsion of the posterior cruciate ligament:

• Posterior cruciate ligament brace

Torus/buckle fracture:

• Nonoperative treatment - Casting

Complete metaphyseal and greenstick fracture:

• Preliminary treatment - Splinting
• Nonoperative treatment – Casting
• Closed reduction - Casting
• Closed reduction - K-wire fixation
• Closed reduction - Screw fixation
• External fixation for temporary stabilization
• Open reduction - K-wire fixation
• Open reduction - Screw fixation
• Open reduction - Plate fixation

Avulsion of the apophysis:

• Preliminary treatment - Splinting
• Nonoperative treatment - Casting
• Open reduction - Screw fixation
• Open reduction - Cerclage compression wiring

The following additional material is available for this module.

Approaches:

• Medial parapatellar approach to the proximal tibia
• Medial approach to the proximal tibia
• Lateral/medial parapatellar arthrotomy of the pediatric proximal tibia
• Anterolateral approach to the proximal tibia
• Arthroscopic approach to the pediatric knee
• Safe zones for pin placement in the pediatric thigh and leg

Patient preparations:

• Patient preparation in supine position
• Patient preparation in supine position for arthroscopy

Further reading:

• Clinical evaluation
• Radiological evaluation
• Complications and technical failures
• Compartment syndrome
• Application of a cylinder cast