Posteromedial plating of proximal tibia fractures

Abstract

Proximal tibial fractures account for approximately 1% of all fractures, with posteromedial involvement
present in 10-30% of cases. Computed tomography (CT) today serves as the gold standard for both
diagnosis and classification. Commonly used CT-based classifications include the three-column theory and
the ten-segment concept. The former emphasizes the consideration of the mechanism of injury in surgical
planning, distinguishing between the compressive and tensile sides of proximal tibial fracture. Additionally,
fragment-specific fracture management should be the objective. Based on several biomechanical studies,
the osteosynthesis of the posteromedial fragment should be carried out with plate fixation, not screws
alone. Appropriate visualization is achievable using the posteromedial modified Lobenhoffer approach,
facilitating anatomical reduction and stable osteosynthesis. Applying these principles of care results in
stable fixation, which is crucial for proximal tibial fractures as it allows faster rehabilitation, thus aiding
in the nutrition of the injured cartilage, preventing arthrofibrosis, and promoting the rapid recovery of
function. Recently, the authors have been applying these principles for the management of affected
patients in their department, sharing their experiences through the presentation of two cases in this
article.