Proximal tibial fractures in adults
- Karl B Fields, MD
Karl B Fields, MD
- Editor-in-Chief — Primary Care Sports Medicine (Adolescents and Adults)
- Section Editor — Biomechanics, Rehabilitation, and Recovery; Sports-Related Injuries; Symptom Assessment and Physical Examination
- Professor of Family Medicine and Sports Medicine
- University of North Carolina at Chapel Hill
- Section Editor
- Patrice Eiff, MD
Patrice Eiff, MD
- Section Editor — Adult Orthopedics; Sports-Related Injuries
- Professor of Family Medicine
- Oregon Health & Science University
- Deputy Editor
- Jonathan Grayzel, MD, FAAEM
Jonathan Grayzel, MD, FAAEM
- Senior Deputy Editor — UpToDate
- Deputy Editor — Emergency Medicine (Adult and Pediatric)
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Assistant Professor of Emergency Medicine
- University of Massachusetts Medical School
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 (figure 1). 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 3).
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 .
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- 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