Treatment of Extra-Articular Proximal Tibial Fracture (Type A)

Clinical Scenario

This protocol applies to proximal tibial fractures that are completely extra-articular — classified as Type A. In this pattern, the fracture line does not extend into the joint surface, making it amenable to nonoperative management in appropriate candidates.

Treatment Approach

Management is nonoperative, centred on closed reduction and cast immobilisation with the knee held in a defined position to counteract deforming muscular forces.

The protocol specifies the precise casting technique, the timing and type of brace transition, and weight-bearing progression — full details in the structured regimen below.

Treatment Goals

Fracture union with anatomical alignment of angulation in the coronal and sagittal planes, and correct rotation.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/s0020-1383(03)00252-3

If the fracture is completely extra-articular, it is a type A.
Nonoperative management of proximal tibia fractures involves closed manipulation of the fracture and placement of a long leg cast.
To minimize the effect of the patellar tendon, it has been suggested that the appropriate position for the knee in a long leg cast is 20 degrees of flexion.
Sarmiento recommended changing to a hinged knee orthosis after an average of three weeks.
Weight bearing can be started according to the comfort of the patient.
Optimal function requires anatomical alignment of angulation in the coronal and sagittal planes and correct rotation.

View source ↗