Proximal Tibial Fractures
Definition
Metaphysical
Extra-articular
Treatment options
IMN
Plate
Results
Jindal et al. Indian J Orthop 2020
- systematic review
- no different in malunion
- infection more common in plate
Metaphysical
Extra-articular
IMN
Plate
Results
Jindal et al. Indian J Orthop 2020
- systematic review
- no different in malunion
- infection more common in plate
Congenital
Acquired
- trauma
- post ACL reconstruction / TKR
- chronic quadriceps rupture
Decreases ROM
Associated with early OA of the PFJ
Blackburne-Peel ratio at 30 degrees flexion
Types
1. Supracondylar
2. Unicondylar
3. Intracondylar
Supracondylar / Extra-condylar
< 60 with good bone stock and preserved joint space
Union rates increased with anatomical reduction
Options
- closed reduction
- open reduction / if closed reduction fails
Accept
- no varus
- < 15o valgus
- < 10o AP plane
Anatomy
L4/5 disc at level of facet joints
Interlaminar space is below disc
- have to take inferior aspect of superior lamina
Pedicle and transverse process at same level
Disc usually on one side
- hemilaminotomy
- no need to remove spinous process
- this preserves stability
Benign enlargement of the common digital branch
- usually 3rd webspace
Found at level of or just distal to MT heads
- deep to the deep transverse MT ligament
Classically women between 40 and 60
Metatarsalgia
- preMT dome
Claw toes
- wide deep toe box
Foot drop
- AFO
Insensate foot
- custom orthosis
Varus
- lateral heel wedge
- AFO (flexible)
- medial iron with lateral T strap
Prospective multi-centred RCT
- 309 displaced intra-articular fractures
- operative v non operative management
- 2 year follow up
Findings
- used patient orientated functional outcomes
- overall VAS and SF36 not significantly different between 2 groups
Improved Operative Outcome if
- not workers compensation
- women
- < 29
90% fusion rates
Lose70% sagittal plane ROM
Non union rates up to 12%
Decreased gait speed
Poor mobility over uneven surfaces
Always use the most lateral scar
- blood supply comes from medial aspect
- want to avoid a large lateral flap of dubious quality
- cross transverse scars at 90o
- minimum 7 cm skin bridge
Options
- can do trial / sham incision down to capsule