From the Guidelines
A long leg posterior splint is the proper choice for a proximal tibial metaphysis injury. This recommendation is based on general medical knowledge, as the provided evidence does not directly address the specific type of splint for a proximal tibial metaphysis injury [ 1 ]. When applying the splint, it is essential to extend it from the upper thigh to beyond the foot, with the knee held in 15-20 degrees of flexion. Some key points to consider when applying the splint include:
- Using 15-20 layers of plaster or fiberglass material along the posterior aspect of the leg, from the gluteal fold to the toes
- Securing it with an elastic bandage
- Positioning the ankle at 90 degrees to prevent foot drop This type of splint is preferred because it effectively immobilizes the knee joint and prevents displacement of the fracture fragments while allowing for swelling that typically occurs after injury. It is crucial to monitor for compartment syndrome by checking distal pulses, sensation, and movement regularly, and instruct the patient to elevate the limb to reduce swelling, as recommended for general fracture care [ 1 ]. The splint should remain in place until definitive treatment is determined, usually after orthopedic consultation.
From the Research
Splinting Options for Proximal Tibial Metaphysis
- A removable knee immobilizer can be used as a proper splint for a proximal tibial metaphysis, as it allows for safe management of buckle fractures without incidence of fracture displacement 2.
- This treatment method is associated with a shorter duration of immobilization and fewer clinic visits, and can also lessen skin issues associated with cast immobilization 2.
- For more complex fractures, such as those involving the proximal tibial metaphyseal region, bridge plating by limited open technique may be an alternative option for select fracture patterns not amenable to intramedullary nailing 3.
Considerations for Splint Selection
- The choice of splint should depend on the specific fracture pattern and patient needs, with consideration given to the potential benefits and drawbacks of each option 2, 3.
- The goal of treatment should be to restore the congruence of the joint surface and axis as accurately as possible, while minimizing complications and promoting optimal outcomes 4, 5.