Extra-articular fractures of the proximal tibial diaphysis: their epidemiology, management and outcome.
In a study of 523 consecutive tibial fractures, 33 were located in the proximal extra-articular segment. There were two fracture groups with different epidemiological characteristics and prognoses: group 1 fractures were metaphyseal in location, follow low-velocity injuries and have a good prognosis with non-operative treatment; group 2 injuries are high-energy diaphyseal fractures. Treatment of these latter fractures proved difficult, with all methods showing significant complications. Overall there was a 26% incidence of malunion, 7% deep infection and 7% compartment syndrome. Only 44% of patients with group 2 fractures returned to full function. Epidemiological analysis showed that proximal tibial fractures are closer to comminuted and segmental fractures in severity than to middle- and distal-third fractures. It is suggested, on the basis of our results, that they should be treated with either compression plating or closed external fixation.
Tytherleigh-Strong
G M
GM
Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, UK.
Keating
J F
JF
Court-Brown
C M
CM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002370:Casts, Surgical / Q000009:adverse effects; D018483:Diaphyses / Q000293:injuries*; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012606:Scotland / Q000453:epidemiology; D013978:Tibial Fractures / Q000453:epidemiology / Q000473:pathology / Q000628:therapy