EXTRAARTICULAR FRACTURES OF THE PROXIMAL TIBIAL DIAPHYSIS - THEIR EPIDEMIOLOGY, MANAGEMENT AND OUTCOME

In a study of 523 consecutive tibial fractures, 33 were located in the proximal extra-articular segment. There were two fracture groups with different epidemiological characteristics and prognoses: group 1 frac tures were metaphyseal in location, follow low-velocity injuries and h ave a good prognosis with non-operative treatment; group 2 injuries ar e high-energy diaphyseal fractures. Treatment of these latter fracture s proved difficult, with all methods showing significant complications . Overall there was a 26% incidence of malunion, 7% deep infection and 7% compartment syndrome. Only 44% of patients with group 2 fractures returned to full function. Epidemiological analysis showed that proxim al tibial fractures are closer to comminuted and segmental fractures i n severity than to middle-and distal-third fractures. It is suggested, on the basis of our results, that they should be treated with either compression plating or closed external fixation.