Proximal tibia fracture fixation
The treatment and surgery that is right for your proximal tibia fracture is determined by a few important factors, including your age, past and current health, symptoms, extent of the injury and any history with medications and other treatments. A proximal tibia fracture is a complete or partial break of the shinbone, close to the knee, which is usually caused by a low-energy impact such as a fall, or a high-energy impact such as a motor vehicle accident.
A proximal tibia fracture can be dangerous because it is connected to the knee, which is a vital joint in the body, with many sensitive ligaments and bones. If you have any reason to believe you may have a fracture in this area, it is important to seek immediate medical attention. Your doctor will ask questions regarding your past health and current symptoms including those related to your knee, and perform a physical exam. To locate the specific area of the breakage, one of the following techniques will be used:
- X-ray (radiograph) – This will be the first test done to diagnose your injury. It is done using electromagnetic radiation, which is sent through your shin and knee area. The bone absorbs the radiation, which allows the image to be created.
- Computed tomography scan (CT or CAT scan) – In some cases, a CAT scan will be used to see if there is any tissue damage. This test combines X-ray technology with computer technology and gives the doctor a little more information.
- Magnetic resonance imaging (MRI) – MRIs are rarely used with this type of injury, but in some cases when there is worry that the blood supply has been compromised, one may be performed. Unlike CAT scan and X-ray technology, no radiation is used. Instead, you will be placed inside a tube where magnetic waves will cause vibrations, which create a high-definition image.
The decision of whether or not to operate on a proximal tibia fracture depends on the lifestyle and overall health of the patient. In some cases it makes sense; however, when there is not an active lifestyle and the patient may have difficulty with anesthesia, operations are not the best choice. In these situations, the patient will be advised not to put any weight on the leg and a cast will be applied to limit motion. As the injury heals, weight and mobility will slowly be reintroduced to the limb.
In most cases involving active adults and children, proximal tibia fracture surgery is performed. The goal of the surgery is to reconnect the bones so that they heal properly. The majority of proximal tibia fractures are treated surgically in one of the following ways:
- Rods – This surgery is done by placing a rod through the marrow canal of the bone to stabilize it and keep the bone in proper position as it heals. This surgery can be done only if there has been no damage to the knee.
- Plates and screws – In the event that there is a bigger break, a plate may be placed next to the bone to keep it in place and screws will be used to stabilize the area. This surgery can be performed on either a fracture that occurs only in the shinbone, or on some occasions a fracture that occurs in the knee joint and shinbone combined.
- Bone graft – In some instances, the ligaments may cause the joint and the shinbone to collapse. This generally occurs when there has been significant trauma to the surrounding area. In this event, a bone graft may be needed to stabilize the area and provide enough bone mass for the ligaments to heal properly.
- External fixation – If there has been a significant amount of damage done to the surrounding tissue, it may be too risky to create an incision. In these cases, external fixation is the preferred method of treatment. This is done using a large rod on the outside of the skin and stabilizing it with screws through the skin into the bone.
There is quite a bit of research being done surrounding the treatment of a proximal tibia fracture. Because this fracture is so close to a joint, and so frequently involves a partial fracture in the knee bone as well, it frequently can lead to other difficulties, including long-term arthritis. This has created a need for physicians to have a better understanding of how best to treat these injuries without the risk of long-term effects.
In some studies, external fixation has been shown to be the best approach to treatment. This is in part because it is the most minimally invasive and provides the most stability to the injury. Internal fixation with plates and screws can sometimes cause a malunion of the bone and joint— that is, an occasion when the fracture does not heal anatomically correctly. This malunion can lead to difficulty down the road, with added strain on the joints from not healing properly. In turn, other difficulties are caused by weight-bearing activities that can be felt in the knee.
Depending on the severity and location of the fracture, some treatments are preferred over others. New treatment methods are being experimented with to determine the best way to treat these injuries. Some new treatment methods include blocking screws to improve alignment after nailing and locking in an extension.
As research on treatment is ongoing, it is a good idea for your conversation about it with your doctor to be ongoing as well.
The multidisciplinary team of trauma and fracture experts at Northwell Health Orthopaedic Institute performs proximal tibia fracture surgery as well as a broad range of nonsurgical and surgical treatments for conditions that affect the bones.