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
- Proximal metaphyseal tibial fractures are complex injuries that require careful management due to their location near the knee joint.
- Treatment depends on fracture displacement, stability, and patient factors.
- For non-displaced or minimally displaced fractures, conservative management with a long leg cast or functional brace for 6-8 weeks may be appropriate.
- For displaced fractures, surgical intervention is often necessary, with options including open reduction and internal fixation (ORIF) using plates and screws, intramedullary nailing, or external fixation in cases with significant soft tissue damage.
- A study published in 2018 compared external fixation with the Ilizarov wire frame and internal fixation with locking plates, and found that fixation of proximal tibia fractures with plates resulted in a slightly shorter healing time compared to Ilizarov frame stabilization 2.
- However, the most recent and highest quality study, published in 2015, recommends external fixation using the femoral LISS plate as a safe and reliable technique with minimal complications and excellent outcomes 1.
Complications
- Malunion, nonunion, infection, and hardware irritation are potential complications to monitor.
- Regular radiographic follow-up is essential to assess healing progress, with typical union occurring within 3-4 months in healthy adults.
- A study published in 2010 found that severity of soft tissue injury was more predictive of outcome than the surgical approach used 3.
Rehabilitation
- Postoperative rehabilitation typically includes early range of motion exercises to prevent knee stiffness, followed by progressive weight bearing and strengthening exercises.
- A study published in 2019 demonstrated the application of a bridge plate by limited open technique for fixation of a proximal tibial metaphyseal fracture, which can be an important alternative option for select fracture patterns not amenable to intramedullary nailing 4.