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Proximal tibia fractures affect the upper part of the long leg bone called the tibia, which extends from the knee to the ankle (i.e. the area known as the shin). Because the proximal end of the tibia extends to the knee, this joint may or may not be affected by proximal tibia fractures. Fractures that enter the knee can cause joint imperfections, irregular joint surfaces, and improper alignment in the legs. This can lead to long-term complications such as joint instability, arthritis, and loss of motion.
Furthermore, proximal tibia fractures can result in injury to the surrounding soft tissues and other systems, including the skin, tendons, ligaments, muscles and nerves. This related injuries must be assessed and treated accordingly.
Please read on to learn more about the anatomy of the tibia bone and surrounding structures, and the causes, symptoms, diagnosis, and treatment of proximal tibia fractures.
Anatomy of the Proximal Tibia
The proximal tibia is the end of the skin bone closest to the knee. Its surface, or the tibial plateau, is considered “cancellous” (or crunchy). Because of the nature of its surface, the tibial plateau is at risk for compression and depression due to injury.
The proximal tibia meets the knee, and fractures to this area of the bone often affect the knee joint (see knee injuries for more information).
Causes of Proximal Tibia Fracture
Proximal tibia fractures can be caused by stress or trauma (in both high and low energy injuries) or in a bone already compromised by disease, such as cancer or infection.
High-energy injuries, more common in younger people, can occur in falls, car or other motor vehicle accidents, and sports related accidents.
Low-impact injuries in older or compromised individuals, can occur with slips and falls, while in motion or even from a standing position.
Pattern of injury
The pattern of the injury is determined based on the location of the fracture and the degree of displacement in the fractured bones. Furthermore, the force of the injury determines its pattern. The force or impact can either be direct (as with contact with the dashboard or front seat in an accident); vertical (as with a fall); bending (as with falls, vehicle accidents or sports injuries); or a combination of these forces.
Symptoms of Proximal Tibia Fracture
The symptoms of a proximal tibia fracture can include:
If any of these symptoms develop following an accident, it is wise to seek emergency medical treatment to diagnose the injury and receive prompt and proper treatment.
Diagnosing Proximal Tibia Fracture
To diagnose a proximal tibia fracture, a doctor will perform both a physical examination and diagnostic imaging tests that can help determine the precise nature and extent of the injury. During a physical examination, the doctor will ask for detailed information about the accident, your symptoms, and your overall health. She or he will then examine the shin, knee, foot, and surrounding tissues—checking for swelling, bruising, open wounds—to determine the severity of the damage to the bone and other systems, such as the nerves and blood.
Diagnostic tests such as x-rays, CT scans and MRIs may also be performed to determine the exact location of the fracture, its pattern, and the displacement of the pieces of fractured bones.
Treatment of Proximal Tibia Fracture
The type of treatment most appropriate for proximal tibia fracture will depend on several factors, including the nature and severity of the fracture, related injuries, and the patient’s age, lifestyle, and overall health. For example, in active patients, surgery may be recommended to maximize joint motion and stability and minimize the risk of complications. However, for patients with other limb problems or health conditions, the risks of surgery may outweigh the benefits.
In some cases, immediately following injury, an external fixator can be used to support and stabilize the leg while minimizing the risk of further damage to the area. In case of damage to surrounding tissues, this may be the best method of final treatment. Another goal of immediate treatment is to minimize the risks of complications such as compartment syndrome (whereby swelling threatens the blood supply to the rest of the leg), and infection.
In cases where an orthopedic expert believes non-surgical treatment would be ideal, braces or casts may be used to stabilize the shin and allow for healing. A patient will be encouraged to stay off the affected leg and restrict their movement for a period until rehabilitative exercises can begin.
If surgery is thought most appropriate, different options may be considered based on the fracture pattern, whether or not the fracture entered into the knee joint, and a number of other factors. In some cases where the joint is not affected, a rod or plate can be surgically placed to stabilize the tibia. Some fractures that have entered the joint can also be treated with the surgical implantation of a plate.
In cases where the fracture has entered the joint and depressed the bones, lifting the fragments of bone may be necessary. However, lifting the bones in this way can cause a defect in the surface of the bone. These defects must be filled using a bone graft to prevent the joint from collapsing and to reduce the risk of arthritis. A bone stimulator can also be used to prompt healing of the bone.
Recovery and a long-term rehabilitation plan will be discussed with the orthopedic specialist. It is important to also speak with a doctor about the long term outcome of proximal tibia fracture, as arthritis and reduced range of motion can occur following such an injury.