title: Extra-articular proximal tibial fractures: nail or plate?
abstract: The surgical goals for treating proximal tibial fractures are to restore articular congruity, the mechanical axis, and knee motion while avoiding soft-tissue complications. The fracture pattern should be correctly identified and understood. For fractures with minimal intra-articular extension, fracture fixation with an intramedullary nail can decrease the risk of infection because it uses a small incision that is not placed directly over the injured soft tissue, and it provides better axial load sharing than a plate. Using the semi-extended technique, choosing the correct starting portal, incorporating blocking screws or stability screws into the fixation construct, and using mini-open reduction and internal fixation of the fracture will help achieve the goals of fracture fixation with an intramedullary nail. All proximal tibial fractures can be treated successfully with a plate or multiple plates. When a plate is used, the surgical approach and technique should minimize soft-tissue damage and account for future surgical procedures that may be needed. Fractures with intra-articular involvement and/or comminution of the medial metaphyseal region are appropriately treated with dual plating. Extra-articular fractures without major medial comminution may be treated with a locked lateral plate. Final union rates for patients treated with either intramedullary nail or plate fixation are reported at 96% and 97%, respectively. A prospective, randomized, multicenter study is currently in progress to further clarify and advance the treatment of proximal tibial fractures.
authors: Boston University Medical Center, Boston, MA, USA.
authors: John C
authors: JC
authors: Kurylo
authors: Paul
authors: P
authors: Tornetta
mesh_terms: D000465:Algorithms; D001858:Bone Nails; D001860:Bone Plates; D005593:Fracture Fixation, Internal / Q000379:methods*; D005594:Fracture Fixation, Intramedullary; D018460:Fractures, Comminuted / Q000601:surgery; D006801:Humans; D010149:Postoperative Pain / Q000517:prevention & control; D013978:Tibial Fractures / Q000601:surgery; D016896:Treatment Outcome