Abstract

• The treatment of proximal tibial fracture is an area of great controversy. Because open and comminuted fractures are common, selection of fixation method of the proximal tibial fracture is more difficult than any other fractures. Many authors reported high rate of malunion and loss of reduction. The purpose of this study is to compare the results of the proximal tibial fractures depending on the fixation method. We evaluated the records of 35 patients (36 fractures) who had been treated with intramedullary nailing, plate and screws and external fixation from January 1989 to January 1996. The mean period of follow-up was 12months. Of the 36 fractures, 8 fractures were with intramedullary nailing, 12 fractures with plate and screws, 16 fractures with external fixator. In intramedullary nailing groupp, the average time of bony union was nineteen weeks (16-27), in plate and screws fixation group twenty three weeks (18-31) and in external fixation group 22 weeks (19-29). The complications of intramedullary nailing group were 3 nonunions, 1 delayed union, 1 varus deformity, 2 anterior angulations and 2 cases of deep wound infection. The complications of plate and screws group were 1 nonunion, 3 delayed union, 1 deep wound infection, 2 superficial infections and in most fractures partial stiffiness of knee joint. The complications of external fixator group were 1 nonunion, 1 delayed union, 1 deep wound infection, 6 pin tract infections and 3 cases of knee joint stiffness. In our cases, if there is open wound higher than Gustilo grade III-B and severe comminuted fracture initially, the external fixation is more preferred for wound management and also more advantageous method for the patients who got a multiple trauma in abdomen, chest and head injuries. In closed fractures and Gustilo grade I, II open fractures, intramedullary nailing is considered to be more preferable method. But the anatomy of proximal tibia made nailing these fractures technically difficult. In conclusion, we consider each method of fixation is useful fixation method of the proximal tibial fractures, but each method should be selected advertently depending on the severity of soft tissue injury and the degree of comminution of the fractures.
• Key words: proximal tibia, intramedullary nailing, plate and screws, external fixator

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