A useful surgical strategy for proximal tibial fractures (AO/OTA type 41-C) with diaphyseal involvement

Relatively few studies have addressed surgical strategy for complex proximal tibial fractures by now. The purpose of this study was to assess the results of a single lateral locking plate using minimally invasive plate osteosynthesis (MIPO) for proximal tibia fractures (AO/OTA type 41-C) with diaphyseal involvement. From Jun 2009 to Jun 2014, 20 patients (fifteen women and five men, mean age 35.8 years) were managed for proximal tibial fractures which extend into the diaphyseal region of the bone, including three 41-C1, eleven 41-C2, and six 41-C3. Twelve patients were open fractures. A single lateral locking plate characterized by percutaneous technology was used with or without additional lag screws. Mobilization was started immediately after the procedure, and non-weight-bearing was maintained for at least 6 weeks, then progressively weight bearing depends on both clinical and x-ray findings. Primary union was achieved by 16 of the 20 study subjects. Early bone grafting was performed in 4 cases with a massive initial bone defect and staged bone grafting was used in one to treat nonunion. The mean articular step off was 1.0 mm (range, 0-3 mm). No patient had misalignment greater than 10°. Acceptable range of knee motion of ≥120° was achieved in sixteen, and the mean knee Hass score was 87.4 at final follow-up visits. The complications included superficial infection in one patient. In conclusion, the surgical strategy can provide favorable results in the treatment of proximal tibial fractures (AO/OTA type 41-C) with diaphyseal involvement.