Extra-articular fractures of the proximal tibial diaphysis: their epidemiology, management and outcome.

In a study of 523 consecutive tibial fractures, 33 were located in the proximal extra-articular segment. There were two fracture groups with different epidemiological characteristics and prognoses: group 1 fractures were metaphyseal in location, follow low-velocity injuries and have a good prognosis with non-operative treatment; group 2 injuries are high-energy diaphyseal fractures. Treatment of these latter fractures proved difficult, with all methods showing significant complications. Overall there was a 26% incidence of malunion, 7% deep infection and 7% compartment syndrome. Only 44% of patients with group 2 fractures returned to full function. Epidemiological analysis showed that proximal tibial fractures are closer to comminuted and segmental fractures in severity than to middle- and distal-third fractures. It is suggested, on the basis of our results, that they should be treated with either compression plating or closed external fixation.