Fracture of the Proximal Tibia 

There are several types of proximal tibia fractures. These are also called tibial plateau fractures. The bone can break straight across (transverse fracture) or into many pieces (comminuted fracture).

Sometimes these fractures extend into the knee joint and separate the surface of the bone into a few (or many) parts. These types of fractures are called intra-articular fractures.

The top surface of the tibia (the tibial plateau) is made of cancellous bone, which has a “honeycombed” appearance and is softer than the thicker bone lower in the tibia. Fractures that involve the tibial plateau occur when a force drives the lower end of the thighbone (femur) into the soft bone of the tibial plateau, similar to a die punch. The impact often causes the cancellous bone to compress and remain sunken, as if it were a piece of styrofoam that has been stepped on.

This damage to the surface of the bone may result in improper limb alignment, and over time may contribute to arthritis, instability, and loss of motion.

Proximal tibia fractures can be closed — meaning the skin is intact — or open. An open fracture is when a bone breaks in such a way that bone fragments stick out through the skin or a wound penetrates down to the broken bone. Open fractures often involve much more damage to the surrounding muscles, tendons, and ligaments. They have a higher risk for problems like infection, and take a longer time to heal.

• Pain that is worse when weight is placed on the affected leg
• Swelling around the knee and limited bending of the joint
• Deformity — The knee may look “out of place”
• Pale, cool foot — A pale appearance or cool feeling to the foot may suggest that the blood supply is in some way impaired.
• Numbness around the foot — Numbness, or “pins and needles,” around the foot raises concern about nerve injury or excessive swelling within the leg.
• If you have these symptoms after an injury, go to the nearest hospital emergency room for an evaluation.

During your first visit, your doctor will talk to you about your symptoms and medical history. During the physical examination, your doctor will check all the structures of your injury, and compare them to your non-injured anatomy.  Most injuries can be diagnosed with a thorough physical examination.

Imaging Tests Other tests which may help your doctor confirm your diagnosis include:

X-rays. Although they will not show any injury, x-rays can show whether the injury is associated with a broken bone.

Magnetic resonance imaging (MRI) scan. If your injury requires an MRI, this study is utilized to create a better image of soft tissues injuries. However, an MRI may not be required for your particular injury circumstance and will be ordered based on a thorough examination by your Peninsula Bone & Joint Clinic Orthopedic physician.

• Timely Care

• Minimally Invasive Procedures

• Advanced Rehabilitation

• Injury Prevention

One of the main goals of sports medicine is to put off major orthopedic surgery (such as joint replacement) as long as possible or even remove the need altogether with physical therapy, minimally invasive arthroscopic surgery and timely care.

When everything is working well, you hardly give them a thought. But when a problem arises, it’s often impossible to ignore.

Nonsurgical treatment may include casting and bracing, in addition to restrictions on motion and weight bearing. Your doctor will most likely schedule additional x-rays during your recovery to monitor whether the bones are healing well while in the cast. Knee motion and weight-bearing activities begin as the injury and method of treatment allow.

Nonsurgical treatment may include casting and bracing, in addition to restrictions on motion and weight bearing. Your doctor will most likely schedule additional x-rays during your recovery to monitor whether the bones are healing well while in the cast. Knee motion and weight-bearing activities begin as the injury and method of treatment allow.

There are a few different methods that a surgeon may use to obtain alignment of the broken bone fragments and keep them in place while they heal.

Internal fixation

During this type of procedure, the bone fragments are first repositioned (reduced) into their normal position. They are held together with special devices, such as an intramedullary rod or plates and screws.

In cases in which the upper one fourth of the tibia is broken, but the joint is not injured, a rod or plate may be used to stabilize the fracture. A rod is placed in the hollow medullary cavity in the center of the bone. A plate is placed on the outside surface of the bone.

Plates and screws are commonly used for fractures that enter the joint. If the fracture enters the joint and pushes the bone down, lifting the bone fragments may be required to restore joint function.

Lifting these fragments, however, creates a hole in the cancellous bone of the region. This hole must be filled with material to keep the bone from collapsing. This material can be a bone graft from the patient or from a bone bank. Synthetic or naturally occurring products which stimulate bone healing can also be used.

Fractures that extend into the knee joint frequently require plate fixation. The plate is applied to the surface of the bone.

Fractures that are sunken must be elevated back up to restore the joint. This reduces the risk of arthritis and instability.

External fixators

In some cases, the condition of the soft tissue is so poor that the use of a plate or rod might threaten it further. An external fixator (described under Emergency Care above) may be considered as final treatment. The external fixator is removed when the injury has healed.