Proximal tibial fractures in adults
- Karl B Fields, MD
Karl B Fields, MD
- Section Editor — Adult Orthopedics
- Section Editor — Primary Care Sports Medicine
- Professor of Family Medicine and Sports Medicine
- University of North Carolina at Chapel Hill
Closed tibial fractures are common long-bone fractures. Greater than 70,000 hospitalizations, 800,000 office visits and 500,000 hospital days, have been attributed to tibial shaft fractures alone. While the elderly suffer many of these fractures from falls, the presence of significant osteoporosis increases the risk for compound or more complex fractures with higher morbidity .
This topic will review issues related to proximal tibial fractures. A general overview of tibial fractures is presented separately. (See "Overview of tibial fractures in adults".)
The tibia is the major weight-bearing bone of the lower leg (picture 1 and picture 2). The proximal portion of the bone, the tibial plateau, forms the lower surface of the knee joint (picture 3). The thicker of the two articular surfaces is the medial tibial condyle, while the lateral tibial condyle is a relatively thinner and weaker portion of the joint. The anatomy of the knee is reviewed in detail separately. (See "Physical examination of the knee", section on 'Anatomy'.)
Separating the medial from the lateral tibial condyle is the intercondylar eminence, an important bony prominence that anchors the attachment of the anterior cruciate ligament (ACL) (picture 4).
Another key bony landmark is the tibial tuberosity which is on the anterior surface, several centimeters below the joint line and the inferior patellar pole, which serves as the attachment site for the patellar tendon .
- Schmidt AH, Finkemeier CG, Tornetta P 3rd. Treatment of closed tibial fractures. Instr Course Lect 2003; 52:607.
- Duke Orthopaedics. Wheeless' Textbook of Orthopedics. www.wheelessonline.com (Accessed 3/7/05).
- Patellar, Tibial, and Fibular Fractures. In: Fracture Management for Primary Care, Eiff MP, Hatch RL, Calmbach WL. (Eds), Saunders, Philadelphia 2003. p.263.
- Mustonen AO, Koivikko MP, Lindahl J, Koskinen SK. MRI of acute meniscal injury associated with tibial plateau fractures: prevalence, type, and location. AJR Am J Roentgenol 2008; 191:1002.
- Colletti P, Greenberg H, Terk MR. MR findings in patients with acute tibial plateau fractures. Comput Med Imaging Graph 1996; 20:389.
- Ziran BH, Becher SJ. Radiographic predictors of compartment syndrome in tibial plateau fractures. J Orthop Trauma 2013; 27:612.
- Tscherne H, Lobenhoffer P. Tibial plateau fractures. Management and expected results. Clin Orthop Relat Res 1993; :87.
- Stevens DG, Beharry R, McKee MD, et al. The long-term functional outcome of operatively treated tibial plateau fractures. J Orthop Trauma 2001; 15:312.
- Rademakers MV, Kerkhoffs GM, Kager J, et al. Tibial spine fractures: a long-term follow-up study of open reduction and internal fixation. J Orthop Trauma 2009; 23:203.
- PERTINENT ANATOMY
- MECHANISM OF INJURY
- SYMPTOMS AND EXAMINATION FINDINGS
- Knee effusion
- Ligamentous and meniscal integrity
- Acute compartment syndrome
- DIAGNOSTIC IMAGING
- DIFFERENTIAL DIAGNOSIS
- MANAGEMENT BY FRACTURE LOCATION
- Tibial plateau fractures
- - Indications for orthopedic referral
- - Initial treatment
- - Follow-up care
- - Return to sport or work
- - Outcomes and complications
- Anterior tibial spine and intercondylar notch fractures
- Tibial tubercle avulsions
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS