From the Research
Proximal metaphyseal tibial fractures should be treated with external fixation using the femoral LISS plate, as it is a safe and reliable technique with minimal complications and excellent outcomes, as demonstrated in a study published in 2015 1.
Key Points
- Proper diagnosis using radiographs and often CT scans to assess fracture configuration and articular involvement is crucial.
- Treatment depends on fracture stability, with non-displaced or minimally displaced fractures potentially managed non-operatively using long leg casting for 6-8 weeks followed by progressive weight bearing.
- Most proximal tibial metaphyseal fractures require surgical fixation, typically with plates and screws, to restore alignment and joint congruity.
- Surgical approaches include medial, lateral, or combined approaches depending on fracture pattern.
- Postoperatively, patients typically remain non-weight bearing for 6-8 weeks, followed by progressive weight bearing as healing progresses.
- Complications to monitor include malunion, nonunion, infection, and post-traumatic arthritis.
- Physical therapy is essential for regaining range of motion and strength.
- Special consideration should be given to associated soft tissue injuries, particularly ligamentous injuries and meniscal tears, which may require additional treatment.
- Long-term outcomes depend on fracture severity, quality of reduction, and rehabilitation compliance.
Treatment Options
- External fixation using the femoral LISS plate is a viable option, as it allows for minimal invasion and excellent outcomes, with a mean healing time of 14 weeks and no cases of nonunion, deep infection, or loosening of screws and plates 1.
- Internal fixation with locking plates is also an option, with a slightly shorter healing time compared to Ilizarov frame stabilization, but with a higher rate of heterotopic ossifications 2.
- Bridge plating by limited open technique is an alternative option for select fracture patterns not amenable to intramedullary nailing 3.
Important Considerations
- Severity of soft tissue injury is a significant predictor of outcome, and treatment approach should be tailored accordingly 4.
- Sociodemographics and soft tissue injury severity are more important than treatment approach for predicting clinical and functional outcomes at 2 years in patients with proximal tibia metaphyseal fractures with severe soft tissue injury 4.