Publication:

Various modalities of treatment of proximal tibial fractures: a prospective longitudinal study

Background Tibial plateau fractures are one of the commonest intra-articular fractures. They result from indirect coronal or direct axial compressive forces. This makes about 1% of all fractures and 8% of the fractures in elderly. Nevertheless, tibial plateau fractures challenging remain because of their number, variety and complexity. With advancements the treatment of each fracture type is still not defined hence we have taken up this study to analyze various fracture patterns and its outcome.

Methods The study includes 40 patients having the fractures of  the proximal tibial metaphyseal; metaphyseodiaphyseal with or without intra-articular extension (including upper third fractures of tibia), closed fractures, fractures with Open grade-I wounds (Gustillo Anderson Classification).The study excludes compound fractures having grade II and III (Gustillo Anderson) and Paediatric patients. The treatment  method  was  based  on  the  type  of  fracture,  the  amount  of displacement , the amount of depression and surrounding skin condition  of the tibial plateau. We used the Schatzker classification because it is closest to describing the specific fracture type and it is easy to apply.

Results In this study there were 40 patients with mean age of 39.18 (median 38.5 and min – max 25 to 55) with 25 male (62.5%) and 15 (37.5%) female with significant male preponderance. In this study road  traffic  accident  was  the  commonest  mode  of  injury  (65%)  and produced different types of fractures, followed by fall from height (22.5%), injury while playing sports (12.5%).

Conclusions The correct method of management of tibial condylar fractures depends on good clinical judgment. If rational treatment is to be instituted the surgeon must have sound knowledge of the personality of the injury and a clear understanding of the knee examination, imaging studies and must be familiar with variety of techniques available at present for treating tibial condyle fractures.