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
Metaphyseal
Extra-articular
Types
1. Supracondylar
2. Unicondylar
3. Intracondylar
Supracondylar / Extra-condylar
Most common long bone fracture
Young patients / sports
Elderly / simple falls
MVA - often compound
Grade 0
- nil ST injury
Grade 1
2 groups
1. Elderly
- low velocity injury
- osteoporotic
- need to start bisphosphonates
2. Young patients
- high velocity injury
Distal Radius Angles
- radial volar tilt 11°
- radial inclination 22°
- radius is 11 mm longer than ulna
- ulna variance 2mm positive on average
>65
Third most common fracture after hip and distal radius
Neck shaft angle 130o
Head retroverted 20o relative to shaft
Anatomical neck (junction of head and metaphysis)
< 20o sagittal
< 30o coronal
< 3 cm of shortening
Intra-articular proximal ulna fracture
Articulates with trochlea
- may have a central bare area
Triceps insertion
- via broad aponeurosis which blends with anconeus and CEO
Undisplaced fracture
- need to ensure triceps mechanism is intact
Primary
- 8 / 52 gestation radius & ulna
Secondary
- distal radius age 1
- distal ulna age 5
< 10: > 15o malalignment
> 10: > 10o malalignment
Varies per age group
Trauma
- 60%
Non Accidental Injury
- 15 - 30%
- suspect if non walker / < 1 year
- walking status single best indicator of risk
- paediatric team to investigate
- history taking from parent
- consider metabolic investigations