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Management of Proximal Tibial Fractures

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Part of the book series: European Instructional Lectures ((EICL,volume 13))

Abstract

Proximal tibial fractures constitute a grossly heterogeneous group of bony injuries. Inevitably, their management varies and depends mainly on the fracture pattern and the condition of the surrounding soft tissues. Although conservative treatment can be attempted in simple, undisplaced fractures (without or with minimal intra-articular involvement), the management of most proximal tibial fractures should be operative, as apart from the necessity for anatomical reduction, surgical treatment will allow immediate knee motion and early weight-bearing and return to pre-injury activities. Minimally-invasive plate osteosynthesis (MIPO) with new locking plates alongside with modern hybrid external fixation devices are mostly used nowadays for the management of intra-and extra-articular fractures of the proximal tibia. However, latest modifications and improvements of intramedullary nailing technique have contributed to its establishment as reliable treatment option for the management of extra-articular proximal tibial fractures. Furthermore, the supplementary use of compression bolts has enabled us to exploit the advantages of intramedullary nailing in the treatment of bi-condylar fractures, a proposal that could change the therapeutic protocols regarding the management of complex intra-articular fractures of the proximal tibia in the future.

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References

  1. Abdel-Hamid MZ, Chang CH, Chan YS, Lo YP, Huang JW, Hsu KY, Wang CJ (2006) Arthroscopic evaluation of soft tissue injuries in tibial plateau fractures: retrospective analysis of 98 cases. Arthroscopy 22(6):669–675

    Article  PubMed  Google Scholar 

  2. Ahmad M, Nanda R, Bajwa AS, Candal-Couto J, Green S, Hui AC (2007) Biomechanical testing of the locking compression plate: when does the distance between bone and implant significantly reduce construct stability? Injury 38(3):358–364. doi:10.1016/j.injury.2006.08.058, S0020-1383(06)00546-8 [pii]

    Article  PubMed  CAS  Google Scholar 

  3. Ali AM, Yang L, Hashmi M, Saleh M (2001) Bicondylar tibial plateau fractures managed with the Sheffield hybrid fixator. Biomechanical study and operative technique. Injury 32(Suppl 4):SD86–SD91. doi:S0020138301001656 [pii]

    PubMed  Google Scholar 

  4. Babis GC, Evangelopoulos DS, Kontovazenitis P, Nikolopoulos K, Soucacos PN (2011) High energy tibial plateau fractures treated with hybrid external fixation. J Orthop Surg Res 6:35. doi:10.1186/1749-799X-6-35, 1749-799X-6-35 [pii]

    Article  PubMed  Google Scholar 

  5. Bennett WF, Browner B (1994) Tibial plateau fractures: a study of associated soft tissue injuries. J Orthop Trauma 8(3):183–188

    Article  PubMed  CAS  Google Scholar 

  6. Berkson EM, Virkus WW (2006) High-energy tibial plateau fractures. J Am Acad Orthop Surg 14(1):20–31. doi:14/1/20 [pii]

    PubMed  Google Scholar 

  7. Bhattacharyya T, McCarty LP 3rd, Harris MB, Morrison SM, Wixted JJ, Vrahas MS, Smith RM (2005) The posterior shearing tibial plateau fracture: treatment and results via a posterior approach. J Orthop Trauma 19(5):305–310

    PubMed  Google Scholar 

  8. Boldin C, Fankhauser F, Hofer HP, Szyszkowitz R (2006) Three-year results of proximal tibia fractures treated with the LISS. Clin Orthop Relat Res 445:222–229. doi:10.1097/01.blo.0000203467.58431.a0

    PubMed  Google Scholar 

  9. Bolhofner BR (1995) Indirect reduction and composite fixation of extraarticular proximal tibial fractures. Clin Orthop Relat Res 315:75–83

    PubMed  Google Scholar 

  10. Buckley R, Mohanty K, Malish D (2011) Lower limb malrotation following MIPO technique of distal femoral and proximal tibial fractures. Injury 42(2):194–199. doi:10.1016/j.injury.2010.08.024, S0020-1383(10)00636-4 [pii]

    Article  PubMed  CAS  Google Scholar 

  11. Buehler KC, Green J, Woll TS, Duwelius PJ (1997) A technique for intramedullary nailing of proximal third tibia fractures. J Orthop Trauma 11(3):218–223

    Article  PubMed  CAS  Google Scholar 

  12. Canadian Orthopaedic Trauma Society (2006) Open reduction and internal fixation compared with circular fixator application for bicondylar tibial plateau ­fractures. Results of a multicenter, prospective, ­randomized clinical trial. J Bone Joint Surg Am 88(12):2613–2623. doi:10.2106/JBJS.E.01416, 88/12/2613 [pii]

    Article  Google Scholar 

  13. Carlson DA (2005) Posterior bicondylar tibial plateau fractures. J Orthop Trauma 19(2):73–78. doi:00005131-200502000-00001 [pii]

    Article  PubMed  Google Scholar 

  14. Catagni MA, Ottaviani G, Maggioni M (2007) Treatment strategies for complex fractures of the tibial plateau with external circular fixation and limited internal fixation. J Trauma 63(5):1043–1053. doi:10.1097/TA.0b013e3181238d88, 00005373-200711000-00013 [pii]

    Article  PubMed  Google Scholar 

  15. Cole PA, Zlowodzki M, Kregor PJ (2004) Treatment of proximal tibia fractures using the less invasive stabilization system: surgical experience and early clinical results in 77 fractures. J Orthop Trauma 18(8):528–535. doi:00005131-200409000-00008 [pii]

    Article  PubMed  Google Scholar 

  16. Court-Brown CM, Caesar B (2006) Epidemiology of adult fractures: a review. Injury 37(8):691–697. doi:10.1016/j.injury.2006.04.130, S0020-1383(06)00323-8 [pii]

    Article  PubMed  Google Scholar 

  17. De Long WG Jr, Einhorn TA, Koval K, McKee M, Smith W, Sanders R, Watson T (2007) Bone grafts and bone graft substitutes in orthopaedic trauma surgery. A critical analysis. J Bone Joint Surg Am 89(3):649–658. doi:10.2106/JBJS.F.00465, 89/3/649 [pii]

    Article  PubMed  Google Scholar 

  18. Delamarter RB, Hohl M, Hopp E Jr (1990) Ligament injuries associated with tibial plateau fractures. Clin Orthop Relat Res 250:226–233

    PubMed  Google Scholar 

  19. Dougherty PJ, Kim DG, Meisterling S, Wybo C, Yeni Y (2008) Biomechanical comparison of bicortical versus unicortical screw placement of proximal tibia locking plates: a cadaveric model. J Orthop Trauma 22(6):399–403. doi:10.1097/BOT.0b013e318178417e, 00005131-200807000-00005 [pii]

    Article  PubMed  Google Scholar 

  20. Duwelius PJ, Rangitsch MR, Colville MR, Woll TS (1997) Treatment of tibial plateau fractures by limited internal fixation. Clin Orthop Relat Res 339:47–57

    Article  PubMed  Google Scholar 

  21. Egol KA, Koval KJ, Zuckerman JD (eds) (2010) Handbook of fractures. Lippincott Williams & Wilkins, Philadelphia

    Google Scholar 

  22. Egol KA, Su E, Tejwani NC, Sims SH, Kummer FJ, Koval KJ (2004) Treatment of complex tibial plateau fractures using the less invasive stabilization system plate: clinical experience and a laboratory comparison with double plating. J Trauma 57(2):340–346. doi:00005373-200408000-00022 [pii]

    Article  PubMed  Google Scholar 

  23. Egol KA, Tejwani NC, Capla EL, Wolinsky PL, Koval KJ (2005) Staged management of high-energy proximal tibia fractures (OTA types 41): the results of a prospective, standardized protocol. J Orthop Trauma 19(7):448–455; discussion 456, doi:00005131-200508000-00003 [pii]

    Article  PubMed  Google Scholar 

  24. Ehlinger M, Adam P, Bonnomet F (2010) Minimally invasive locking screw plate fixation of non-articular proximal and distal tibia fractures. Orthop Traumatol Surg Res 96(7):800–809. doi:10.1016/j.otsr.2010.03.025, [pii] S1877-0568(10)00147-7

    Article  PubMed  CAS  Google Scholar 

  25. Estes C, Rhee P, Shrader MW, Csavina K, Jacofsky MC, Jacofsky DJ (2008) Biomechanical strength of the Peri-Loc proximal tibial plate: a comparison of all-locked versus hybrid locked/nonlocked screw configurations. J Orthop Trauma 22(5):312–316. doi:10.1097/BOT.0b013e31817279b8, 00005131-200805000-00005 [pii]

    Article  PubMed  Google Scholar 

  26. Finkemeier CG (2002) Bone-grafting and bone-graft substitutes. J Bone Joint Surg Am 84-A(3):454–464

    PubMed  Google Scholar 

  27. Freedman EL, Johnson EE (1995) Radiographic ­analysis of tibial fracture malalignment following intramedullary nailing. Clin Orthop Relat Res 315:25–33

    PubMed  Google Scholar 

  28. Gardner MJ, Yacoubian S, Geller D, Suk M, Mintz D, Potter H, Helfet DL, Lorich DG (2005) The incidence of soft tissue injury in operative tibial plateau ­fractures: a magnetic resonance imaging analysis of 103 patients. J Orthop Trauma 19(2):79–84. doi:00005131-200502000-00002 [pii]

    Article  PubMed  Google Scholar 

  29. Garnavos C, Kanakaris NK, Lasanianos NG, Tzortzi P, West RM (2012) New classification system for long-bone fractures supplementing the AO/OTA classification. Orthopedics 35(5):e709–e719. doi:10.3928/01477447-20120426-26

    Article  PubMed  Google Scholar 

  30. Garnavos C, Lasanianos N (2011) Proximal tibia fractures and intramedullary nailing: the impact of nail trajectory to varus/valgus deformity. Injury 42(12):1499–1505. doi:10.1016/j.injury.2011.05.003, S0020-1383(11)00183-5 [pii]

    Article  PubMed  CAS  Google Scholar 

  31. Garnavos C, Lasanianos NG (2011) The management of complex fractures of the proximal tibia with minimal intra-articular impaction in fragility patients using intramedullary nailing and compression bolts. Injury 42(10):1066–1072. doi:10.1016/j.injury.2011.03.024, S0020-1383(11)00119-7 [pii]

    Article  PubMed  Google Scholar 

  32. Gaudinez RF, Mallik AR, Szporn M (1996) Hybrid external fixation of comminuted tibial plateau fractures. Clin Orthop Relat Res 328:203–210

    Article  PubMed  Google Scholar 

  33. Gazdag AR, Lane JM, Glaser D, Forster RA (1995) Alternatives to autogenous bone graft: efficacy and indications. J Am Acad Orthop Surg 3(1):1–8

    PubMed  Google Scholar 

  34. Gerber A, Ganz R (1998) Combined internal and external osteosynthesis a biological approach to the treatment of complex fractures of the proximal tibia. Injury 29(Suppl 3):C22–C28

    Article  PubMed  Google Scholar 

  35. Gosling T, Schandelmaier P, Marti A, Hufner T, Partenheimer A, Krettek C (2004) Less invasive stabilization of complex tibial plateau fractures: a biomechanical evaluation of a unilateral locked screw plate and double plating. J Orthop Trauma 18(8):546–551. doi:00005131-200409000-00011 [pii]

    Article  PubMed  CAS  Google Scholar 

  36. Gosling T, Schandelmaier P, Muller M, Hankemeier S, Wagner M, Krettek C (2005) Single lateral locked screw plating of bicondylar tibial plateau fractures. Clin Orthop Relat Res 439:207–214. doi:00003086-200510000-00036 [pii]

    Article  PubMed  CAS  Google Scholar 

  37. Gustilo RB, Anderson JT (1976) Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am 58(4):453–458

    PubMed  CAS  Google Scholar 

  38. Haidukewych G, Sems SA, Huebner D, Horwitz D, Levy B (2007) Results of polyaxial locked-plate fixation of periarticular fractures of the knee. J Bone Joint Surg Am 89(3):614–620. doi:10.2106/JBJS.F.00510, 89/3/614 [pii]

    Article  PubMed  Google Scholar 

  39. Hak DJ (2011) Intramedullary nailing of proximal third tibial fractures: techniques to improve reduction. Orthopedics 34(7):532–535. doi:10.3928/01477447-20110526-19

    Article  PubMed  Google Scholar 

  40. Hiesterman TG, Shafiq BX, Cole PA (2011) Intramedullary nailing of extra-articular proximal tibia fractures. J Am Acad Orthop Surg 19(11):690–700. doi:19/11/690 [pii]

    PubMed  Google Scholar 

  41. Higgins TF, Klatt J, Bachus KN (2007) Biomechanical analysis of bicondylar tibial plateau fixation: how does lateral locking plate fixation compare to dual plate fixation? J Orthop Trauma 21(5):301–306. doi:10.1097/BOT.0b013e3180500359, 00005131-200705000-00003 [pii]

    Article  PubMed  Google Scholar 

  42. Honkonen SE (1995) Degenerative arthritis after tibial plateau fractures. J Orthop Trauma 9(4):273–277

    Article  PubMed  CAS  Google Scholar 

  43. Jiang R, Luo CF, Wang MC, Yang TY, Zeng BF (2008) A comparative study of Less Invasive Stabilization System (LISS) fixation and two-incision double plating for the treatment of bicondylar tibial plateau fractures. Knee 15(2):139–143. doi:10.1016/j.knee.2007.12.001, S0968-0160(07)00197-4 [pii]

    Article  PubMed  Google Scholar 

  44. Katsenis D, Dendrinos G, Kouris A, Savas N, Schoinochoritis N, Pogiatzis K (2009) Combination of fine wire fixation and limited internal fixation for high-energy tibial plateau fractures: functional results at minimum 5-year follow-up. J Orthop Trauma 23(7):493–501. doi:10.1097/BOT.0b013e3181a18198, 00005131-200908000-00002 [pii]

    Article  PubMed  Google Scholar 

  45. Keogh P, Kelly C, Cashman WF, McGuinness AJ, O’Rourke SK (1992) Percutaneous screw fixation of tibial plateau fractures. Injury 23(6):387–389

    Article  PubMed  CAS  Google Scholar 

  46. Koval KJ, Helfet DL (1995) Tibial plateau fractures: evaluation and treatment. J Am Acad Orthop Surg 3(2):86–94

    PubMed  Google Scholar 

  47. Koval KJ, Sanders R, Borrelli J, Helfet D, DiPasquale T, Mast JW (1992) Indirect reduction and percutaneous screw fixation of displaced tibial plateau fractures. J Orthop Trauma 6(3):340–346

    Article  PubMed  CAS  Google Scholar 

  48. Krettek C, Gerich T, Miclau T (2001) A minimally invasive medial approach for proximal tibial fractures. Injury 32(Suppl 1):SA4–SA13

    PubMed  Google Scholar 

  49. Krettek C, Stephan C, Schandelmaier P, Richter M, Pape HC, Miclau T (1999) The use of Poller screws as blocking screws in stabilising tibial fractures treated with small diameter intramedullary nails. J Bone Joint Surg Br 81(6):963–968

    Article  PubMed  CAS  Google Scholar 

  50. Lachiewicz PF, Funcik T (1990) Factors influencing the results of open reduction and internal fixation of tibial plateau fractures. Clin Orthop Relat Res 259:210–215

    PubMed  Google Scholar 

  51. Lang GJ, Cohen BE, Bosse MJ, Kellam JF (1995) Proximal third tibial shaft fractures. Should they be nailed? Clin Orthop Relat Res (315):64–74

    Google Scholar 

  52. Lasanianos N, Mouzopoulos G, Garnavos C (2008) The use of freeze-dried cancelous allograft in the management of impacted tibial plateau fractures. Injury 39(10):1106–1112. doi:10.1016/j.injury.2008.04.005, S0020-1383(08)00182-4 [pii]

    Article  PubMed  CAS  Google Scholar 

  53. Lindvall E, Sanders R, Dipasquale T, Herscovici D, Haidukewych G, Sagi C (2009) Intramedullary nailing versus percutaneous locked plating of extra-articular proximal tibial fractures: comparison of 56 cases. J Orthop Trauma 23(7):485–492. doi:10.1097/BOT.0b013e3181b013d2, 00005131-200908000-00001 [pii]

    Article  PubMed  Google Scholar 

  54. Liporace FA, Stadler CM, Yoon RS (2013) Problems, tricks, and pearls in intramedullary nailing of proximal third tibial fractures. J Orthop Trauma 27(1):56–62. doi:10.1097/BOT.0b013e318250f041

    Article  PubMed  Google Scholar 

  55. Lowe JA, Tejwani N, Yoo B, Wolinsky P (2011) Surgical techniques for complex proximal tibial fractures. J Bone Joint Surg Am 93(16):1548–1559

    PubMed  Google Scholar 

  56. Mahadeva D, Costa ML, Gaffey A (2008) Open reduction and internal fixation versus hybrid fixation for bicondylar/severe tibial plateau fractures: a systematic review of the literature. Arch Orthop Trauma Surg 128(10):1169–1175. doi:10.1007/s00402-007-0520-7

    Article  PubMed  CAS  Google Scholar 

  57. Mallik AR, Covall DJ, Whitelaw GP (1992) Internal versus external fixation of bicondylar tibial plateau fractures. Orthop Rev 21(12):1433–1436

    PubMed  CAS  Google Scholar 

  58. Marsh JL, Slongo TF, Agel J, Broderick JS, Creevey W, DeCoster TA, Prokuski L, Sirkin MS, Ziran B, Henley B, Audige L (2007) Fracture and dislocation classification compendium - 2007: Orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma 21(10 Suppl):S1–S133. doi:00005131-200711101-00001 [pii]

    Article  PubMed  CAS  Google Scholar 

  59. Marsh JL, Smith ST, Do TT (1995) External fixation and limited internal fixation for complex fractures of the tibial plateau. J Bone Joint Surg Am 77(5):661–673

    PubMed  CAS  Google Scholar 

  60. Moore TM, Patzakis MJ, Harvey JP (1987) Tibial plateau fractures: definition, demographics, treatment rationale, and long-term results of closed traction management or operative reduction. J Orthop Trauma 1(2):97–119

    Article  PubMed  CAS  Google Scholar 

  61. Mueller KL, Karunakar MA, Frankenburg EP, Scott DS (2003) Bicondylar tibial plateau fractures: a biomechanical study. Clin Orthop Relat Res 412:189–195. doi:10.1097/01.blo.0000071754.41516.e9

    Article  PubMed  Google Scholar 

  62. Nikolaou VS, Tan HB, Haidukewych G, Kanakaris N, Giannoudis PV (2011) Proximal tibial fractures: early experience using polyaxial locking-plate technology. Int Orthop 35(8):1215–1221. doi:10.1007/s00264-010-1153-y

    Article  PubMed  Google Scholar 

  63. Nork SE, Barei DP, Schildhauer TA, Agel J, Holt SK, Schrick JL, Sangeorzan BJ (2006) Intramedullary nailing of proximal quarter tibial fractures. J Orthop Trauma 20(8):523–528. doi:10.1097/01.bot.0000244993.60374.d6, 00005131-200609000-00001 [pii]

    Article  PubMed  Google Scholar 

  64. Papagelopoulos PJ, Partsinevelos AA, Themistocleous GS, Mavrogenis AF, Korres DS, Soucacos PN (2006) Complications after tibia plateau fracture surgery. Injury 37(6):475–484. doi:10.1016/j.injury.2005.06.035, S0020-1383(05)00232-9 [pii]

    Article  PubMed  Google Scholar 

  65. Parekh AA, Smith WR, Silva S, Agudelo JF, Williams AE, Hak D, Morgan SJ (2008) Treatment of distal femur and proximal tibia fractures with external fixation followed by planned conversion to internal fixation. J Trauma 64(3):736–739. doi:10.1097/TA.0b013e31804d492b, 00005373-200803000-00023 [pii]

    Article  PubMed  Google Scholar 

  66. Partenheimer A, Gosling T, Muller M, Schirmer C, Kaab M, Matschke S, Ryf C, Renner N, Wiebking U, Krettek C (2007) Management of bicondylar fractures of the tibial plateau with unilateral fixed-angle plate fixation. Unfallchirurg 110(8):675–683. doi:10.1007/s00113-007-1271-1

    Article  PubMed  CAS  Google Scholar 

  67. Phisitkul P, McKinley TO, Nepola JV, Marsh JL (2007) Complications of locking plate fixation in complex proximal tibia injuries. J Orthop Trauma 21(2):83–91. doi:10.1097/BOT.0b013e318030df96, 00005131-200702000-00001 [pii]

    Article  PubMed  Google Scholar 

  68. Ricci WM, O’Boyle M, Borrelli J, Bellabarba C, Sanders R (2001) Fractures of the proximal third of the tibial shaft treated with intramedullary nails and blocking screws. J Orthop Trauma 15(4):264–270

    Article  PubMed  CAS  Google Scholar 

  69. Ricci WM, Rudzki JR, Borrelli J Jr (2004) Treatment of complex proximal tibia fractures with the less ­invasive skeletal stabilization system. J Orthop Trauma 18(8):521–527. doi:00005131-200409000-00007 [pii]

    Article  PubMed  Google Scholar 

  70. Sarmiento A, Kinman PB, Latta LL, Eng P (1979) Fracutres of the proximal tibia and tibial condyles: a clinical and laboratory comparative study. Clin Orthop Relat Res 145:136–145

    PubMed  Google Scholar 

  71. Savoie FH, Vander Griend RA, Ward EF, Hughes JL (1987) Tibial plateau fractures. A review of operative treatment using AO technique. Orthopedics 10(5):745–750

    PubMed  CAS  Google Scholar 

  72. Schatzker J, McBroom R, Bruce D (1979) The tibial plateau fracture. The Toronto experience 1968-1975. Clin Orthop Relat Res (138):94–104

    Google Scholar 

  73. Schutz M, Kaab MJ, Haas N (2003) Stabilization of proximal tibial fractures with the LIS-System: early clinical experience in Berlin. Injury 34(Suppl 1):A30–A35

    Article  PubMed  Google Scholar 

  74. Shepherd L, Abdollahi K, Lee J, Vangsness CT Jr (2002) The prevalence of soft tissue injuries in nonoperative tibial plateau fractures as determined by magnetic resonance imaging. J Orthop Trauma 16(9):628–631

    Article  PubMed  Google Scholar 

  75. Stannard JP, Wilson TC, Volgas DA, Alonso JE (2003) Fracture stabilization of proximal tibial fractures with the proximal tibial LISS: early experience in Birmingham, Alabama (USA). Injury 34(Suppl 1):A36–A42

    Article  PubMed  Google Scholar 

  76. Stannard JP, Wilson TC, Volgas DA, Alonso JE (2004) The less invasive stabilization system in the treatment of complex fractures of the tibial plateau: short-term results. J Orthop Trauma 18(8):552–558. doi:00005131-200409000-00012 [pii]

    Article  PubMed  Google Scholar 

  77. Subasi M, Kapukaya A, Arslan H, Ozkul E, Cebesoy O (2007) Outcome of open comminuted tibial plateau fractures treated using an external fixator. J Orthop Sci 12(4):347–353. doi:10.1007/s00776-007-1149-7

    Article  PubMed  Google Scholar 

  78. Tscherne H, Gotzen L (1984) Fractures with soft tissue injuries. Springer, New York

    Book  Google Scholar 

  79. Tscherne H, Lobenhoffer P (1993) Tibial plateau ­fractures. Management and expected results. Clin Orthop Relat Res (292):87–100

    Google Scholar 

  80. Vangsness CT Jr, Ghaderi B, Hohl M, Moore TM (1994) Arthroscopy of meniscal injuries with tibial plateau fractures. J Bone Joint Surg Br 76(3):488–490

    PubMed  Google Scholar 

  81. Vince KG, Abdeen A (2006) Wound problems in total knee arthroplasty. Clin Orthop Relat Res 452:88–90. doi:10.1097/01.blo.0000238821.71271.cc, 00003086-200611000-00017 [pii]

    Article  PubMed  Google Scholar 

  82. Watson JT (1994) High-energy fractures of the tibial plateau. Orthop Clin North Am 25(4):723–752

    PubMed  CAS  Google Scholar 

  83. Watson JT, Ripple S, Hoshaw SJ, Fhyrie D (2002) Hybrid external fixation for tibial plateau fractures: clinical and biomechanical correlation. Orthop Clin North Am 33(1):199–209, ix

    Article  PubMed  Google Scholar 

  84. Weninger P, Tschabitscher M, Traxler H, Pfafl V, Hertz H (2010) Influence of medial parapatellar nail insertion on alignment in proximal tibia ­fractures-special consideration of the fracture level. J Trauma 68(4):975–979. doi:10.1097/TA.0b013e3181a4c1f0

    PubMed  Google Scholar 

  85. Weninger P, Tschabitscher M, Traxler H, Pfafl V, Hertz H (2010) Intramedullary nailing of proximal tibia fractures-an anatomical study comparing three lateral starting points for nail insertion. Injury 41(2):220–225. doi:10.1016/j.injury.2009.10.014, S0020-1383(09)00537-3 [pii]

    Article  PubMed  Google Scholar 

  86. Wysocki RW, Kapotas JS, Virkus WW (2009) Intramedullary nailing of proximal and distal one-third tibial shaft fractures with intraoperative two-pin external fixation. J Trauma 66(4):1135–1139. doi:10.1097/TA.0b013e3181724754, 00005373-200904000-00027 [pii]

    Article  PubMed  Google Scholar 

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Acknowledgements

The author would like to thank Dr. Konstantinos Dudulakis for his contribution with the drawings in the text.

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Correspondence to Christos Garnavos MD, PhD .

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Garnavos, C. (2013). Management of Proximal Tibial Fractures. In: Bentley, G. (eds) European Instructional Lectures. European Instructional Lectures, vol 13. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-36149-4_8

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