Executive Editor: Ernst Raaymakers, Joseph Schatzker, Rick Buckley

Authors: Matthias Hansen, Rodrigo Pesantez

Proximal tibia Extraarticular fracture, avulsion of tibial tubercle

back to skeleton

Glossary

General considerations

41-A1.2

This fracture is most often the result of a sudden quadriceps contraction. It may also be associated with a knee dislocation. Therefore, check carefully for knee stability and associated neurovascular injuries.

Nonoperative treatment
Indication summary Skill Equipment
Undisplaced or minimally displaced fracture 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.

Lag screws
Indication summary Skill Equipment
Displaced/unstable fracture, knee instability Some specialized surgical experience Simple surgical and imaging resources

Indications

  • Displaced and/or unstable fracture
  • If associated with knee dislocation

Contraindications

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

Disadvantage

  • 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