Proximal Tibia Fractures – Reduction and Stabilization

Posted by on Nov 5, 2014 | 3 comments

The literature has many articles about reduction of proximal tibia fractures. These include using blocking screws, provisional plating and suprapatella approach( the fracture is reamed and the nail is introduced above the patella to enter the bone entrance of the tibia)

SIGN surgeons have solved the problem of reduction of the proximal tibia by using the figure 4 position as shown in the technique manual. Please put your own leg in the figure 4 position and you can see why a valgus malreduction is unlikely.

The proximal fragment above the fracture should be pressed into flexion by the surgical assistant. Using this position of figure 4 and pressing the proximal fragment will reduce the fracture. During this technique of flexion of both the knee and the fragment, the reamer and nail does not strike the patella as they are inserted. The fracture site therefore is reduced.

We have not found it necessary to place the incision more lateral which also decreases the possibility of valgus malreduction.

3 Responses to “Proximal Tibia Fractures – Reduction and Stabilization”

  1. Nicholas Antao says:

    Sometimes there are situations depending upon the fracture geometry. One may not get the good intended reduction. What one can do is use a small 4 hole plate, slide it percutaneously on the medial side to hold the reduction by drilling only on cortex and using the screw to fix the fracture.You might have to bend the plate to adapt to the curve of the bone.Then u may use only 2 screws with 2 cortices on either side of the fracture or 4 screws in very long fragments with 4 cortices. Most of the time you will succeed.Then you must do the procedure of sign nailing. You may keep the plate on.Nicholas Antao

  2. Mahmoud Abdel-Ghany says:

    I have a little experience in the proximal tibial fractures treated by ILN just I have about 11 cases.
    it is a different nails used for prox. tibial fractures only one case I did with SIGN nail. usually we have some deformities which necessitate further intervention however sliding bolt lessen the displacement. But as a surgeon I am not satisfying with proximal tibial fractures treated by nail. whatever the nail.

  3. Nicholas Antao says:

    Iam about to send my paper role of sign nail in upper third fractures for publication after approval from dr. Zirkle. We have over 4o cases. I use a midline incision, split the ligamentum patella, remove some piece of fat fad anterior to the inter meniscal ligamnet, and put my entry point in the midlinein front of the intermeniscal ligamnet.The knee is hyperflexed, but additional useof Esmacs bandage encircling the fracture fragmnets helps according to me to keep the fracture reduced. I normally sink the nail inside about half a centimetre, since comminuted fractures there is overriding of the top of the nail after collapse.To avoid this one also use a nail a centimetre less than the normal measurement.I have never used polar screws. Nicholas Antao Mumbai India

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