MANAGEMENT OF FRACTURES OF PROXIMAL TIBIA -A NEW TREATMENT MODALITY

Abstract

Various modalities of treatment for intra/extra articular fractures of proximal tibia include, traction, open reduction and internal fixation by plates and screws, percutaneous screw fixation with or without external fixation, and recently introduced minimally invasive techniques. These methods have achieved varied success rates but the problems encountered have been prolonged recumbency with traction and dangers of extensive soft tissue stripping, infection and knee stiffness with internal fixation methods. Pin problems continue to haunt external fixators apart from poor acceptability of the frame by the patients. Encouraged with the excellent results achieved by us with intra- medullary inter-locking nail for complex fractures of distal femur, we have used the same device for selected cases of fractures of the proximal tibia during the last 5 years.

We used this method in 46 patients of which 43 were available for analysis. Twenty-one were open fractures and 34 had intra-articular extension. Six were floating knee injuries and 2 had an associated fracture of the patella. In all cases knee mobilization was started within 48 hours after the surgery. If associated injuries did not prevent, non-weight bearing crutch walking was started within a week and partial weight bearing within 3 weeks. Thirty-nine of the fractures have united at an average of 14 weeks and four are still being followed up. Thirty-seven have regained at least 90% of the original movement. There has been no infection except in two patients with Grade III open fracture, which settled after the implant was removed following fracture healing. There has been one delayed union, which is progressing to union after bone grafting.

Our early experiences with this implant are extremely encouraging as it provides adequate stabilization of the fracture without any soft tissue stripping and allows early mobilization of the joint and the patient.