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Proximal Tibial Epiphysis
- Infrequent injuries
- Usually by direct force
- Usually SH II
- Very high incidence of vascular injury to popliteal vessel
Treatment
- Undisplaced – cast treatment
- Displaced – closed reduction & if unstable crosssed pins
- If intraarticular need exact reduction
- Monitor post-reduction for neurovascular status
Proximal Tibial Metaphysis
- Usually incomplete fracture with valgus
- Mold in varus & full extension
- May get valgus deformity – in general wait up to 3 years for correction
Tibial Diaphysis
- Most uncomplicated tibial fractures are managed in a cast
- Growth acceleration of 5-7 mm
- Acceptable Reduction
- Valgus & varus of 5°
- Recurvatum of 10°
Operative Indications
- Open fracture
- Compartment syndrome
- Polytrauma
- Soft tissue injury
- Failed closed management
Techniques of Fixation
- External Fixation
- 4 mm half pins in kids
- 5-6 mm half pins in adolescents
- IM
- generally not amenable until skeletal maturity
- Compression Plates
