Executive Editor: Ernst Raaymakers, Joseph Schatzker, Rick Buckley

Authors: Matthias Hansen, Rodrigo Pesantez

Proximal tibia Extraarticular fracture, avulsion of fibular head

back to skeleton

Glossary

General considerations

41-A1.1

These fractures are most often displaced because of the distracting forces acting on it.

Avulsion of the attachment of the lateral collateral ligament may be associated with dislocation of the knee and be a much more serious injury. Check the stability and if unstable, the neurovascular status of the limb.

Nonoperative treatment
Indication summary Skill Equipment
Undisplaced or minimally displaced, and stable Basic surgical experience, no specialized skills Basic equipment only

Indications

  • Undisplaced or minimally displaced, and stable fracture
  • Patient who cannot tolerate surgery
  • Very elderly patients

Contraindication

  • Open injury

Advantage

  • No risks of surgery

If fracture displaces, surgery is indicated.

Tension band fixation
Indication summary Skill Equipment
Varus instability, displaced and/or unstable fracture Some specialized surgical experience Simple surgical and imaging resources

Indications

  • Extraarticular fracture of the fibular head
  • Displaced and/or unstable
  • Varus instability of the knee

Contraindications

  • Serious soft-tissue complications
  • Several serious medical co-morbidities

Advantages

  • A tension band is stronger than a single screw

Disadvantages

  • Risk of peroneal nerve injury
  • Surgical risks
Lag screws
Indication summary Skill Equipment
Varus instability, large fibular head fragment Some specialized surgical experience Simple surgical and imaging resources

Most often this fracture cannot be completely neutralized by lag screw fixation alone.

Indications

  • Extraarticular fracture of the fibular head
  • Varus instability of the knee
  • Displaced and/or unstable

Contraindications

  • Serious soft-tissue complications
  • Several serious medical co-morbidities

Disadvantages

  • Most often this fracture cannot be completely neutralized by lag screw fixation alone
  • Risk of peroneal nerve injury
  • Risks of surgery
Suture anchors
Indication summary Skill Equipment
Unstable knee based on ligament injury Basic surgical experience, no specialized skills Basic equipment only

Indications

  • Ligamentous instability and/or fracture dislocation with capsular avulsions

Contraindications

  • Serious soft-tissue complications
  • Several serious medical co-morbidities

Advantages

  • Suture anchors provide the best fixation in soft tissues and near a joint

Disadvantages

  • Risk of peroneal nerve injury
  • Surgical risks
  • Stiffness of the joint
*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

v2.0 2010-05-15