Executive Editor: Ernst Raaymakers, Joseph Schatzker

Authors: Matthias Hansen, Rodrigo Pesantez

Proximal tibia

back to skeleton

Glossary

Basic treatment techniques

Basic technique: Modular external fixation

Surgical procedures sorted by fracture type

Use this menu to jump directly into a specific classification (optional):
A1.1 A1.2 A1.3 A2 A3 B1 B2 B3 C1 C2 C3
A1.1

Extraarticular fracture, avulsion of fibular head

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment Undisplaced or minimally displaced, and stable Basic surgical experience, no specialized skills Basic equipment only
Tension band fixation Varus instability, displaced and/or unstable fracture Some specialized surgical experience Simple surgical and imaging resources
Lag screws Varus instability, large fibular head fragment Some specialized surgical experience Simple surgical and imaging resources
A1.2

Extraarticular fracture, avulsion of tibial tuberosity

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment Undisplaced or minimally displaced fracture Basic surgical experience, no specialized skills Basic equipment only
Lag screws Displaced/unstable fracture, knee instability Some specialized surgical experience Simple surgical and imaging resources
A1.3

Extraarticular fracture, avulsion of cruciate insertion

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment Undisplaced and stable fracture Basic surgical experience, no specialized skills Basic equipment only
Lag screws Single large fragment without comminution, associated knee dislocation Some specialized surgical experience Basic equipment only
Tension band fixation Single small fragment without comminution, associated knee dislocation Highly experienced and skilled surgeon Full specialized surgical and imaging resources
A2

Extra-articular fracture, metaphyseal simple

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment Undisplaced or minimally displaced, stable Basic surgical experience, no specialized skills Basic equipment only
Bridging external fixator (temporary) Provisional means of fixation in severely traumatized patients Some specialized surgical experience Simple surgical and imaging resources
Modular external fixation with large pins (definitive) Sufficiently large fragment and the fracture does not communicate with the joint Some specialized surgical experience Simple surgical and imaging resources
Hybrid external fixation (definitive) Open fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Ring external fixation (definitive) Severe soft-tissue injury or bone loss Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Angular stable plate (LISS) Displaced/unstable, short proximal fragment, open fractures, intact fibula, compartment syndrome, osteoporosis Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Plates without angular stability Displaced/unstable, good soft tissues, good bone quality Highly experienced and skilled surgeon Simple surgical and imaging resources
A3

Extra-articular fracture, metaphyseal multifragmentary

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment Undisplaced or minimally displaced, stable Basic surgical experience, no specialized skills Basic equipment only
Bridging external fixator (temporary) Provisional means of fixation in severely traumatized patients Some specialized surgical experience Simple surgical and imaging resources
Modular external fixation with large pins (definitive) Sufficiently large fragment and the fracture does not communicate with the joint Some specialized surgical experience Simple surgical and imaging resources
Hybrid external fixation (definitive) Open fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Ring external fixation (definitive) Severe soft-tissue injury or bone loss Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Angular stable plate (LISS) Displaced/unstable, short proximal fragment, open fractures, intact fibula, compartment syndrome, osteoporosis Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Plates without angular stability Displaced/unstable, good soft tissues, good bone quality, compartment syndrome Highly experienced and skilled surgeon Simple surgical and imaging resources
B1

Partial articular fracture, pure split

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment Undisplaced or minimally displaced and stable Basic surgical experience, no specialized skills Basic equipment only
Bridging external fixation (temporary) Provisional means of fixation in severely traumatized patients Some specialized surgical experience Simple surgical and imaging resources
Hybrid external fixation (definitive) Severe open fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Ring external fixator Severe open fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Percutaneous lag screws B1.1 fractures in young adults, displacement, excellent bone quality, meniscus not trapped in fracture Highly experienced and skilled surgeon Simple surgical and imaging resources
Lag screws Failed indirect reduction, good bone stock, displacement, large fragment Some specialized surgical experience Simple surgical and imaging resources
Plates without angular stability Failed indirect reduction, any operable B1 fracture, especially B1.3, young patients without severe osteoporosis Highly experienced and skilled surgeon Simple surgical and imaging resources
B2

Partial articular fracture, pure depression

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment Undisplaced, minimally impacted and stable Basic surgical experience, no specialized skills Basic equipment only
Bridging external fixation (temporary) Provisional means of fixation in severely traumatized patients Some specialized surgical experience Basic equipment only
Ring external fixation (definitive) Severe open fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Plates without angular stability All displaced B2 fractures with knee joint instability, open fractures, compartment syndrome Highly experienced and skilled surgeon Simple surgical and imaging resources
B3

Partial articular fracture, split-depression

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment Undisplaced/stable, medical compromise, initial temporary splintage, marked osteoporosis Basic surgical experience, no specialized skills Basic equipment only
Bridging external fixation (temporary) Provisional means of fixation in severely traumatized patients Some specialized surgical experience Simple surgical and imaging resources
Hybrid external fixation (definitive) Severe open fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Ring external fixation (definitive) Severe open fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Plates without angular stability All displaced B3 fractures with knee joint instability, open fractures, compartment syndrome Highly experienced and skilled surgeon Simple surgical and imaging resources
C1

Complete articular fracture, articular simple, metaphyseal simple

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment Undisplaced, minimally displaced and stable fractures Basic surgical experience, no specialized skills Basic equipment only
Bridging external fixation (temporary) Provisional means of fixation in severely traumatized patients Some specialized surgical experience Simple surgical and imaging resources
Hybrid external fixation (definitive) Severe open fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Ring external fixation (definitive) Severe open fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Angular stable plate (LISS) Articular, unstable fractures, open fractures, osteoporosis, soft-tissue compromise Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Plates without angular stability All displaced C1 fractures with knee joint instability, open fractures, compartment syndrome Highly experienced and skilled surgeon Full specialized surgical and imaging resources
C2

Complete articular fracture, articular simple, metaphyseal multifragmentary

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment Undisplaced/stable, medical compromise, initial temporary splintage, marked osteoporosis Basic surgical experience, no specialized skills Basic equipment only
Bridging external fixator (temporary) Provisional means of fixation in severely traumatized patients Basic surgical experience, no specialized skills Basic equipment only
Hybrid external fixator Severe open fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Ring external fixator Severe open fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Angular stable plate (LISS) Simple articular fractures, osteoporosis, minimal soft-tissue compromise, surgeon's preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Conventional plates All displaced operable 41-C2 fractures; knee instability, open fractures, compartment syndrome Highly experienced and skilled surgeon Full specialized surgical and imaging resources
C3

Complete articular fracture, articular multifragmentary

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment Stable, medical compromise, initial temporary splintage, marked osteoporosis Basic surgical experience, no specialized skills Basic equipment only
Bridging external fixator (temporary) Provisional means of fixation in severely traumatized patients Basic surgical experience, no specialized skills Basic equipment only
Hybrid external fixator Severe open fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Ring external fixator Severe open fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Conventional plates All operable 41-C3 fractures; knee instability, open fractures, compartment syndrome Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Less invasive stabilization system Osteoporosis, minimal soft-tissue compromise, less traumatic than conventional plating, surgeon's preference, knee instability, compartment syndrome Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Special considerations

Principles of management of open fractures
Complications
Infection
Compartment syndrome
*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 2016-11-21