Proximal Third Tibia Fractures

Question 1

What is the common deformity seen with proximal tibia malunion?

Answer 1

1) Valgus (anterior tibia muscles, pes anserinus)

2) Procurvatum (quadriceps pull)

Question 2

Lateral plating of proximal tibia fractures with long LISS plates place what structure at risk?

Answer 2

Peroneal nerve

Closest to hole 13 on the plates

Question 3

What is the typical starting point for a tibia nail?

Answer 3

Just medial to the lateral tibial spine, and anterior to the articular margin
In proximal tibia fractures a medial starting point can accentuate a valgus deformity; a touch lateral may help prevent deformity in proximal tibia fractures

Question 4

What are techniques that can help prevent a valgus deformity in proximal tibia fractures?

Answer 4

1) Blocking (Poller) screw on lateral side
2) A more lateral starting point
3) short one-third tubular plate placed (unicortical) anteriorly, anteromedially, or posteromedially across fracture
4) Universal distractor
5) semiextended nailing or suprapatellar nail (prevents procurvatum but not valgus)

Question 5

Where would you place blocking screws to prevent the typical valgus and procurvatum deformity in tibia shaft fractures?

Answer 5

Place screws on concavity of anticipated deformity

1) Valgus: place on lateral side of nail in proximal frag
2) Procurvatum: place in posterior half of proximal frag

Question 6

What is the incidence of malunion when nailing proximal tibia fractures?

Answer 6

20-60%