Surgical Management of Proximal Tibial Fracture with Plate Osteosynthesis

Abstract

Background: The majority of proximal tibia fractures are caused by articular extension and can occur as a result of high-speed collisions or falls from considerable heights, when fractures are caused by indirect shear pressures and direct axial compression, respectively. Due to the poor resistance of subchondral bone to axially directed stresses, Depression fractures are relatively common in the elderly with osteopenic bones. Objectives: To study functional outcome of proximal tibia fractures managed by plate osteosynthesis Subjects and Methods: There were 30 patients with proximal tibial fractures scheduled for surgery. Using a study proforma, a detailed history was obtained, with real emphasis paid to the mechanism of injury. Baseline investigations are included in evaluations. The history and physical examination were used to examine other associated symptoms. Six weeks following surgery, the first follow-up appointment was scheduled. Patients were followed up on every 4-6 weeks until radiographic evidence of fracture union was observed. Results: Out of 30 Cases, Male predominance was seen with 80% and females were 20%. The male : female ratio was 4:1. In 90% of the cases Open reduction and internal fixation (ORIF) technique was used. In 10% of the cases Minimally invasive percutaneous plate osteosynthesis (MIPPO) technique was used The average time for proximal tibia fracture union was 18 weeks (range from 18-24 weeks). 67% had an excellent clinical outcome, 20% had good clinical outcome, 7% each had fair and poor clinical outcome. Conclusion: The best technique to treat a proximal tibial fracture is to balance soft-tissue treatment with fracture reduction and alignment. At midterm follow-up, there was no significant difference in the functional outcome of these fractures between single plating and dual plating.