Executive Editor: Ernst Raaymakers, Joseph Schatzker, Rick Buckley

Authors: Matthias Hansen, Rodrigo Pesantez

Proximal tibia

back to skeleton

Glossary

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
Suture anchors Unstable knee based on ligament injury Basic surgical experience, no specialized skills Basic equipment only

Extraarticular fracture, avulsion of tibial tubercle

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
Suture anchors Unstable knee based on ligament injury Basic surgical experience, no specialized skills Basic equipment only

Extraarticular fracture, avulsion of tibial spine

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

Extraarticular 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
Non-bridging external fixator (definitive) Sufficiently large fragment and the fracture does not communicate with the joint Some specialized surgical experience Simple surgical and imaging resources
Hybrid external fixator (definitive) Open fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Ring external fixator (definitive) Severe soft-tissue injury or bone loss Highly experienced and skilled surgeon Full specialized surgical and imaging resources
MIO - 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
ORIF - Plates without angular stability Displaced/unstable, good soft tissues, good bone quality Highly experienced and skilled surgeon Simple surgical and imaging resources

Extraarticular fracture, metaphyseal wedge or 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
Non-bridging external fixator (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
MIO - 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
ORIF - Plates without angular stability Displaced/unstable, good soft tissues, good bone quality, compartment syndrome Highly experienced and skilled surgeon Simple surgical and imaging resources

Partial articular fracture, 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 (definitive) Severe open fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources
MIO - Percutaneous lag screws Lateral plateau fractures in young adults, displacement, excellent bone quality, meniscus not trapped in fracture Highly experienced and skilled surgeon Simple surgical and imaging resources
ORIF - Lag screws Failed indirect reduction, good bone stock, displacement, large fragment Some specialized surgical experience Simple surgical and imaging resources
ORIF - Plates without angular stability Failed indirect reduction, any operable fractures, especially oblique fractures, young patients without severe osteoporosis Highly experienced and skilled surgeon Simple surgical and imaging resources

Partial articular fracture, 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
ORIF - Plates without angular stability All displaced fractures with knee joint instability, open fractures, compartment syndrome Highly experienced and skilled surgeon Simple surgical and imaging resources

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
ORIF - Plates without angular stability All displaced fractures with knee joint instability, open fractures, compartment syndrome Highly experienced and skilled surgeon Simple surgical and imaging resources

Complete articular fracture, simple articular, simple metaphyseal

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
MIO - Angular stable plate (LISS) Articular, unstable fractures, open fractures, osteoporosis, soft-tissue compromise Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - Plates without angular stability All displaced fractures with knee joint instability, open fractures, compartment syndrome Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Complete articular fracture, simple aricular, multifragmentary metaphyseal

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 (definitive) Severe open fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Ring external fixator (definitive) Severe open fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources
MIO - 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
ORIF - Conventional plates All displaced operable fractures; knee instability, open fractures, compartment syndrome Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Complete articular fracture, fragmentary articular

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 (definitive) Severe open fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Ring external fixator (definitive) Severe open fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - Conventional plates All operable fractures; knee instability, open fractures, compartment syndrome Highly experienced and skilled surgeon Full specialized surgical and imaging resources
MIO - 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
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 2010-05-15