Proximal Tibial Fractures

Fractures of the proximal tibia usually result from a lateral bending force (eg, when a car strikes a pedestrian from the side). For elderly persons with severe osteoporosis, a simple fall to the side can fracture the proximal tibia.

Patients present with knee pain and effusion, proximal tibial tenderness, and inability to bear weight. Typically, displaced fractures can be seen on standard anteroposterior and lateral x-ray views, but oblique views may be needed to detect occult fractures. Fat globules in blood aspirated from the knee joint also indicate an occult fracture.

Prognosis and Treatment

Treatment depends on how much of the articular surface is displaced. Stable fractures in which the joint surface is depressed < 5 to 8 mm (< 0.2 to 0.3 inches) can be managed with a cast or brace that holds the knee in full extension. Weight bearing is recommended as tolerated.

For more severe fractures with extensive displacement of the articular surface and structural instability, treatment depends on the patient's activity level and medical condition. Active healthy patients benefit from closed reduction and surgical stabilization of the fracture with metal implants and bone grafting. Patients may need to avoid placing weight on the injured leg for 1 to 2 months. For inactive, debilitated patients, use of a cast or brace with weight bearing as tolerated may be more appropriate. For patients with limited ambulatory ability, function may be satisfactorily restored despite considerable deformity. If pain and dysfunction are unacceptable after the fracture has healed, total knee replacement is an option.