Abstract

• The management of extra-articular proximal tibial fracture remains controversy. Many reporters recognized that the proximal tibial facture are best treated by closed reduction and long leg cast, however delayed union with this method have frequently been documented in spite of anatomical characteristics of proximal tibia. Thirty patients of the fracture of extra-articular Froximal tibia were treated and managed at the Department of Orthopaedic Surgery, Ewha University Hospital from January, 1583 to December 1989.
  The following results were obtained:
  1. According to Gerard classification, anterior long oblique & posterior long oblique fracture were 18 cases(60%) and 8 cases(27%) respectively. Delayed union developed in 9 cases(50%) of 18 cases anterior long oblique fracture and 2 cases(25%) of 8 cases posterior long oblique fracture.
  2. All cases of deleyed union of tibia developed through or below the tuberosity.
  3. Among 30 cases, the fractures were managed with closed method at 23 cases, open method at 7 cases, internal fixation at 12 cases without delayed union and external fixator at 10 cases. The all cases using external fixator resulted in delayed union.
  4. Among 30 cases, 16 cases(53%) were open fracture, and the most common type was type IIIb. Delayed union developed in 8 cases(50%) of 9 cases(56%) type IIIb.
  5. The 24 cases (80%) of fibular fracture were concurred with proximal tibial fracture, and delayed union developed in 10 cases (42% ) of 24 cases fibular fracture and one case of 6. cases without fibular fracture.
  In conclusion, many delayed unions were frequent. In our experience, in case of GradeIII open comminuted fractures, we used external fixation methods mostly, so delayed unions were developed. But after management of soft tissue injury, healing time were short with bone graft as soon as possible, We consider that in cases in which internal fixation was possible according to soft tissue injury, delated unions are prevented by internal fixation using plate and screws or retrograde flexible nails.
• Key words: Fracture, proximal tibia, delayed union

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